What is Extracorporeal Shockwave Lithotripsy (ESWL)?

Extracorporeal Shockwave Lithotripsy (ESWL) refers to the procedure of breaking kidney stones into tiny pieces using shock waves.

ESWL is often performed as an outpatient treatment, which means you do not have to spend a night in the healthcare facility or hospital after the procedure.

Fragmented kidney stone pieces would then be expelled out of the body through the passage of urine. If your stone is larger, you may require more therapies.

What is EWSL?

ESWL is a procedure that uses a machine called a lithotripter to deliver a sequence of shock waves. The shock waves are transmitted towards the affected kidney, and these waves pass through the skin and tissue, focusing on breaking down the kidney stones into smaller, fragmented pieces. These fragmented pieces are expelled out of the body through the passage of urine, and this can take up to several weeks after therapy.

What are the symptoms that indicate kidney stones?

Any person that’s suffering from kidney stones would benefit from this procedure. 

Symptoms include:

• Sharp pain in the lower sides and back portion of the body
• Radiating pain towards the lower abdomen area and groin
• Painful or burning sensation when passing urine

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What are the risks factors associated with EWSL?

The following group of people needs to check with their doctor on the risk factors involved with EWSL:

• Pregnant patients
• Patients who are using “blood thinners” or who have a bleeding condition 
• Patients have a ureteric blockage or scar tissue that may prevent stone fragments from passing
• Patients with cystine and certain forms of calcium-based stones, as these stones do not fragment easily
• Patients who have cardiac pacemakers should inform their physicians. Before the operation, make sure to share any concerns you have with your doctor
• Obesity may make lithotripsy more difficult

What are the complications of EWSL?

ESWL can pose the following complications:

• The passage of stone pieces causes pain
• As a result of stone particles becoming lodged in the urinary stream, urine flow is obstructed. A ureteroscope may be required to remove the shards
• Infection of the urinary tract
• Bleeding around the kidney’s periphery

What are the complications related to EWSL?

ESWL is a safe procedure. However, there are some hazards that patients should be aware of:

• Bleeding and Transfusion: A hematoma (bleeding in and around the kidney) is a rare complication that may necessitate a blood transfusion. Despite this, transfusion rates for ESWL are typically less than 1%. 
• Infection: Despite the fact that patients get an intravenous antibiotic right before ESWL, urinary infections can still occur, resulting in high fevers and chills. Although most infections may be managed with oral antibiotics, individuals may need to be readmitted to the hospital for intravenous antibiotics in rare circumstances.
• Tissue or Organ Injury: Injury to the surrounding skin, tissue, nerves, muscles, and organs (liver, spleen, small and large intestines, pancreas, and kidney) can occur after ESWL. The majority of injuries are small, heal on their own, and do not require additional treatment.
• Incomplete Stone Fragmentation: Although ESWL is a useful treatment for kidney and ureteral stones, its effectiveness relies on several factors, including the size and nature of the stones. Multiple sessions of EWSL might be required.
• Hypertension and diabetes: Hypertension, particularly diastolic hypertension, is a possible side effect of SWL. It’s highly advisable to check with your doctor before getting EWSL.

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How to prevent EWSL treatment?

Here are a few tips to help you prevent kidney stones from developing: 

1) Keep yourself hydrated

The best strategy to avoid kidney stones is to drink more water. Your urine output will be modest if you don’t drink enough. When you have low urine production, your urine is more concentrated and less likely to have a greater concentration of urinary salts, which can lead to stones.

2) Increase your calcium intake 

The calcium oxalate stone is the most frequent type of kidney stone, causing many people to wrongly believe that they should avoid calcium. But in fact, low-calcium diets can raise your risk of developing kidney stones and osteoporosis, hence it’s recommended to consume a healthy level of calcium.

 3) Consume less salt

Calcium kidney stones are more likely to occur if you eat a high-salt diet. If there is too much salt in the urine, calcium cannot be reabsorbed into circulation. A high calcium level in the urine is the result, which might lead to kidney stones. By eating less salt, you can reduce the amount of calcium in your urine. 

4) Reduce your intake of oxalate-rich foods

Keeping oxalate-rich foods to a minimum may help avoid the formation of stones.

• Spinach
• Chocolate 
• Sweet potatoes
• Coffee 
• Peanuts
• Items made from rhubarb and soy
• Bran from wheat

5) Vitamin C supplements should be avoided

Supplementing with vitamin C (ascorbic acid) can lead to kidney stones, especially in men. Men who took large dosages of vitamin C supplements had a twofold increased chance of developing a kidney stone. But Vitamin C from food sources does not pose the same risk.

A Note from Apollo Hospitals/Apollo Group

ESWL is a non-invasive treatment method to break up large kidney stones into smaller pieces, allowing them to be expelled through urine. If you’re suffering from kidney stones, you should consult your Apollo doctor and confirm if your condition can be treated with ESWL.

Frequently Asked Questions

1) Is anesthesia required for the ESWL procedure?

Even though ESWL is an outpatient procedure, doctors may suggest the use of anesthesia depending on the severity of the kidney stone condition. Anesthesia also helps in relaxing the patients when the procedure is performed.

2) Is it necessary to admit the patient for the ESWL procedure?

In most cases, ESWL is an outpatient procedure, which means the patient can leave the hospital once the treatment is done. But if required, your Apollo doctor may suggest that you get admitted for observation and monitoring the recovery after the procedure. 

3) Are there any special precautions to be taken after ESWL is administered?

After treatment, the patient should be able to move around without the need for support. Most patients can return to their normal routine within a day or two. Your Apollo doctor would advise drinking sufficient every day to aid the passage of the kidney stone fragments.