Lithotripsy (ESWL)

Preliminary Information:

  1. Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive means of breaking up kidney or ureteral stones to facilitate passage of smaller fragments later on.
  2. There are a variety of indications for doing this procedure depending on stone size and location. Your physician will go over reasons for choosing this approach versus any other options.
  3. There are some instances when a small stent (tube) is placed in the ureter between the kidney and bladder to prevent the pain of renal outflow obstruction as stone fragments are passing.
  4. The procedure is done on an outpatient basis and generally takes an hour to complete.
  5. 5. You will need to stop taking aspirin, coumadin, or any other blood thinning medications for one week prior to procedure (4 days for coumadin). Advil, Tylenol, and other narcotic pain relievers like vicodin are okay.

Procedure:

  1. ESWL is carried out under a general anesthetic, so you will not be allowed anything to eat or drink for 8 hours prior to procedure.
  2. There are generally 1,000 to 2,400 individual shocks delivered and this is done under x-ray guidance to localize the stone.
  3. You will be in the recovery room for 1 hour post procedure and to a step down unit thereafter. Depending on how well this goes you may be home within an hour or 2 thereafter.
  4. You will not be allowed to drive yourself home following this surgery.

Post-Procedure:

  1. Expect that there will be some blood in the urine and some discomfort in the region of the shock wave delivery. This should be controlled by oral analgesics.
  2. 2. You will be asked to strain the urine for a period of time afterward to collect any stone fragments that pass. These can be stored dry in a baggy or in the stone collection device to be brought into the office later for lab analysis testing.
  3. You can return to work the following day if you are feeling well enough.
  4. If there is a stent left in the ureter during the procedure, there may be a drawstring left protruding through the urethra (urinary outflow channel) to facilitate this stent's easy retrieval later in the office.
  5. Follow up in the office will generally be in 1 to 2 weeks. An hour or so prior to appointment, we generally request that the patient go to a radiology office for a follow up abdominal x-ray to determine the adequacy of the stone fragmentation.
  6. Lithotripsy for stone eradication is a good means of treating the problem, but nonetheless there are times when the procedure needs to be repeated, or other adjunctive procedures employed, as residual stones may remain in 10-15% of patients.