What Is Extracorporeal Shock Wave Lithotripsy?
Extracorporeal shockwave lithotripsy is used to break stones into smaller particles. The stones which cannot pass through urine by themselves or obstruct the flow of urine can be treated by this method. It is a non-invasive technique and can be used to treat stones larger than the diameter of the ureter. The ureter is a tube that connects the kidneys with the urinary bladder. It carries urine from the kidneys to the bladder. When an obstruction is caused by a stone larger than the diameter of the ureter, urine gets collected in the kidneys and leads to kidney impairment. Therefore it is mandatory to remove the stones causing obstruction.
Extracorporeal means outside the body. The shock waves in the extracorporeal method are applied to the affected region from outside the body. The shock waves lead to the larger stone's fragmentation into tiny particles that can be passed through urine. ESWL is a non-surgical technique for treating stones using high-energy shock waves.
What Is Lithotripsy?
Lithotripsy is a medical procedure to crush stones. This procedure uses ultrasonic energy from shockwaves to treat the stones. In Latin, litho means stone, and tripsy means crushing. So it is a stone-crushing treatment inside the body. A kidney ultrasound to locate the stones is done before the treatment. This treatment helps prevent invasive surgical procedures required to remove the stone.
-
Extracorporeal Shockwave Lithotripsy (ESWL) - The technique uses pressure waves to treat kidney stones and break them into pieces. Local or regional anesthesia may be required to undergo the treatment.
-
Ultrasonic Lithotripsy- The high-frequency sound waves are used to locate and target kidney stone without causing damage to the surrounding tissues and organs.
-
Electrohydraulic Lithotripsy (EHL) - Electrical shock waves are used to break the stones into pieces that can pass through the urine. This procedure is performed under general anesthesia.
What Are the Uses of Extracorporeal Shockwave Lithotripsy?
ESWL is used in the cases where-
-
The composition of the stone is cysteine (amino acid) and a certain type of calcium that does not break well with the shock waves.
-
The patient chooses to undergo a non-invasive technique over invasive.
-
The stones are located in narrow ducts that cannot be passed by themselves to where they can be extracted easily.
-
The stones larger than the diameter of the ducts cannot be extracted easily, even after they are broken up into fragments.
-
Stones have been broken down into fragments, but the fragments are still bigger to be extracted.
-
Stones present in the pancreatic duct, bile duct, and gallbladder are treated using this technique.
What Is the Procedure for Extracorporeal Shockwave Lithotripsy?
-
Step One - The patient needs to change from normal clothes into the hospital gown and lay down on the lithotripter bed. A lithotripter is a device that passes electromagnetic shock waves to treat kidney stones.
-
Step Two - The kidney stone is located using X-rays or ultrasound techniques.
-
Step Three - Local or regional anesthesia is given before the procedure.
-
Step Four - The location pointed using an X-ray or ultrasound is then targeted using the shock wave generator. The frequency and intensity of the shockwaves are changed accordingly by the technician. The treatment may take 40 minutes to an hour.
-
Step Five - After the treatment, hospitalization may or may not be required. The physician may prescribe some medications like calcium antagonists or alpha-blockers, which help the stones to come out easily. The patient needs to drink a lot of water for several weeks after the treatment so that the fragments of the stone pass out quickly. Other treatments that can be used if ESWL is not appropriate are ureteroscopy or percutaneous nephrolithotomy.
What Are the Risk Factors Associated With Extracorporeal Shockwave Lithotripsy?
-
ESWL is safe and has very few risks and complications associated with it. The shock waves used in the treatment target the stone only without damaging the surrounding tissues and organs. However, some patients can have the risk of complications after an ESWL.
-
A high risk of complications can occur in people suffering from bleeding disorders and who are on medication with blood thinners. Such patients should stop taking the medication under the guidance of the physician.
-
Pregnant women.
-
Patients who have an implant or a device such as a pacemaker should not undergo the treatment.
-
When the patient needs the stone to be removed urgently and completely (which is not possible using this technique).
-
Patients present with chronic infections.
What Are the Pros and Cons of Extracorporeal Shockwave Lithotripsy?
-
This procedure is non-surgical and hence does not require any medical preparation for the physician as well as the patient.
-
The ESWL treatment does not require hospitalization or a larger sitting time for the treatment.
-
This technique can treat larger stones that cannot be reached.
-
The treatment does not ensure the complete removal of the stone.
-
There will be pain even if there is no incision to the body. To compensate for the pain, mild sedation is generally prescribed by the physician.
-
It can be risky and complicated in patients who are having pacemakers, having medications used for blood thinning, pregnant women, and patients having chronic infections.
-
There are chances of problems occurring after the treatment, like bleeding in the kidney, damage around the kidney stone, and larger fragments of the stone that do not pass through the urine.
Conclusion
ESWL is a pressure wave technique that removes the stones in small ducts that cannot pass out easily. It is a non-invasive and non-surgical procedure in which shock waves are applied to the skin outside the body. This procedure requires minimal medical preparations for the patient and the physician. To read the stone, the physician manages shock waves of different intensities and frequencies. The stone is then broken down into smaller tiny particles which can be easily passed out through the urine. Thus, it removes the blockage caused by the stone and relieves the pain and discomfort caused by the presence of stone inside the body.
