Extracorporeal shock wave lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy is used to treat 80 to 90 percent of kidney stones. Kidney stones smaller than 1.5 cubic centimeters (roughly the size of a marble) that are not located in the lower third of the ureter are usually treated with ESWL. ESWL is a noninvasive procedure that uses shock waves to break up the kidney stone in situ (in place).

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Shock waves are zones of high pressure that travel through fluid, retaining their energy until a solid object is encountered. Shock waves are used to treat kidney stones because they can pass through the bones and tissues of the body without dissipating any energy, yet pulverize a kidney stone on impact. Once the stone has been crumbled, the fragments pass through the urinary tract and out of the body. For kidney stones located in the lower third of the ureter, the pelvis bone interferes with the imaging of the stone required for this procedure, so these stones are removed using a ureteroscope [LINK TO treat.ureteroscope].

Preparing for the procedure may require limiting food and water, depending on the type of sedation to be used. The shock waves can be painful, so the procedure is usually performed using full sedation or general anesthesia, but on an outpatient basis. The procedure begins by either partially submerging the patient in a tub of water while he or she sits in a chair or having the patient recline on a water-filled cushion. Shock waves are then directed at the kidney stone while X-rays or ultrasound are used to monitor the location and status of the stone. The shock waves pound the stone until it crumbles and is passed in the urine. This usually requires 1,000 to 2,000 shock waves and takes approximately 30 minutes. Shock waves are loud, so patients wear earphones to protect their hearing during the procedure.

Recovery is quick; usually patients are able to leave the treatment center within a few hours. Normal activity can be resumed in two to three days. Fluid intake is encouraged to help pass the stone fragments. Some stone fragments may be too large to pass, and additional treatment with ESWL may be necessary. The likelihood of needing additional treatment depends largely on the experience of the urologist and the capability of the equipment to emit high-energy shock waves. Approximately 2 to 25 percent of people undergoing ESWL will need additional treatment to remove the kidney stone.

Approximately 1 million people have had this treatment since it was approved by the Federal Drug Administration in 1985. Documented side effects from this procedure include blood in the urine for a short time, minor bruising on the back or abdomen, and some discomfort as the stone fragments pass through the urinary tract. Recent data suggest a potentially increased incidence of diabetes or hypertension in patients who have undergone ESWL. Further research is underway to assess this potential link between ESWL and diabetes or hypertension.