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Lithotripsy - ESWL
Reference Summary

Introduction
Kidney stones are fairly common. Although kidney stones can be very painful, they are
treatable, and in many cases preventable.
Your doctor may recommend Extracorporeal Shock
Wave Lithotripsy, or ESWL, to treat your kidney
stones. The decision to have this procedure is
yours.
This reference summary will help you understand
the treatment options for kidney stones, specifically
Extracorporeal Shock Wave Lithotripsy, or ESWL. It
discusses the causes and symptoms of kidney
stones and their treatment options. The benefits
and risks of ESWL are also presented, followed by
what to expect after the procedure.
Anatomy
Most people are born with two kidneys. Kidneys are
bean-shaped organs on both sides of the spine.
Kidney

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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Ureter
Bladder
The main function of the kidneys is to regulate the
amount of water in the body and to remove harmful
chemicals known as toxins from your blood. The
kidneys secrete these toxins into urine.
Urine flows through tubes called ureters to the bladder,
where it is stored. When the bladder is full, people feel
the urge to urinate. The urine is emptied through the urethra.
Kidney Stones
A persons urine can be high in minerals. If these minerals become too concentrated,
they can form crystals, which may then combine and form small, hard stones in your
kidney. These stones vary in size from a few millimeters to a few inches.
When these stones become dislodged from the kidney, they
travel down the ureters to the bladder.
Kidney
Stone
Most people are able to pass these stones without a problem.
Some people, however, experience severe pain when the stones travel
through the ureters.
This pain is usually located in the back, flank, or groin area, and can
last from five to fifteen minutes at a time. This pain is known as renal
colic.
Kidney stones can also get stuck in the ureters. If this occurs, the pain can persist for
days and the urine flow from the kidney to the bladder might be blocked. This can lead
to urine back pressure on the kidney, which may result in
the loss of the kidney. Therefore, it is important to remove
these stones.
Pain is often the most noticeable symptom of kidney
stones. Other symptoms that indicate kidney stones
include:
nausea,
vomiting,
bloody or foul-smelling urine,
and the constant urge to urinate.

Treatment Options
Depending on the patients symptoms, as well as the size and location of the stone,
the urologist, a physician specialized in kidney and bladder diseases, may just wait
and see if the patient can pass the stone on his or her own.

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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Patients are usually given medication to help with the severe pain. Patients are asked
to drink a lot of fluid, approximately 12 eight-ounce glasses a day, to help flush out the
kidney. This is known as expectant therapy.

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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If the symptoms are not very severe, medication can be
given in some cases to change the composition of the urine
and help dissolve the stone. This takes a long time and is not
a good option in cases of severe pain or urinary obstruction.
If pain persists and the patient has not been able to pass the
stone, further treatment may be tried. The urologist may
decide to go to the site of the stone using a scope placed through the urethra and
bladder into the ureter. There the stone can be fished out using special baskets, or
broken down with a laser or other mechanical devices. This procedure is known as
Ureteroscopic Stone Removal.
Sometimes the urologist can only reach the stone by making an incision in the back
and placing the scope into the kidney and down the ureter. This surgical procedure is
known as Percutaneous Stone Removal.
The least invasive way to deal with these stones remains ESWL, or Extracorporeal
Shock Wave Lithotripsy, which is discussed next.
The doctor considers the size, number, location and composition of the stones when
recommending a treatment option. The patients size and medical condition are other
factors to consider when exploring treatment options.
ESWL
During ESWL, the urologist breaks down the stone with
shock waves. No incisions are done and usually no
instruments are inserted into the body. A urologist is a
physician specialized in kidney and bladder diseases.
The waves, also called sound waves, turn the stone to
sand, which is then passed out of the body easily with
urine. In some cases, where the stone is large, the
urologist may insert a stent before the ESWL to help
the fragmented stone pass without discomfort.
About one to two thousand shock waves are needed to crush the stone. The entire
treatment takes about 45 to 60 minutes. ESWL is usually an outpatient procedure,
which means the patient goes home the same day of the procedure. There are two
methods of shock wave treatment. In one method, the patient is placed in a tub of
lukewarm water. In the second, more common method, the patient lies on a soft
cushion or membrane through which the waves pass.
ESWL is usually done under general anesthesia. General anesthesia puts the patient
to sleep so he or she does not feel any pain.
The urologist will first locate the stone using X-rays or ultrasounds. The urologist then
targets shock waves at the stone through the body using a special machine. This
causes the stone to crumble and become smaller. These smaller pieces should pass
easier. The machine used to generate the shock waves makes a loud noise. The
patient is given protective headphones to wear during the procedure to protect the
eardrums.
Risks and Complications
ESWL is a very safe and effective operation. Risks and
complications are exceedingly rare.
If general anesthesia is used, its risks include nausea, vomiting,
urinary retention, cut lips, chipped teeth, sore throat, and
headache. More serious risks of general anesthesia include
heart attack, stroke, and pneumonia. Your anesthesiologist will
discuss these risks with you and ask you if you are allergic to
certain medications.
Blood clots in the legs can occur due to inactivity during and after
the procedure. These usually show up a few days after the
procedure. They cause the leg to swell and hurt.
Blood clots can become dislodged from the leg and go to the lungs,
where they will cause shortness of breath, chest pain and possibly
death. It is extremely important to let your doctors know if any of
these symptoms occur. Sometimes the shortness of breath can
happen without warning. Getting out of bed shortly after the
procedure may help decrease the risk of blood clots in the legs.

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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Most patients have some blood in the urine for a few days. The broken stone pieces
may cause discomfort as they pass through urine.
Sometimes, the stone is not completely shattered, and the ESWL procedure may need
to be repeated. Some stones are found to be very tough and resistant to ESWL. This
may lead the urologist to suggest other methods to
remove the stone.
After the Procedure
After the procedure, you will stay in the recovery room
for up to 2 hours. ESWL is usually an outpatient
procedure, which means the patient goes home the
same day.
Since you will have anesthesia, it is important that
someone drive you home.
After treatment is complete, you can move about almost at once. Most people can fully
resume daily activities one to two days after ESWL.
The urologist will suggest that you drink plenty of water in the weeks following the
procedure. This will increase the rate of urination, which helps the remaining pieces of
stone pass from the body.
Most patients have a small amount of blood in their urine after the procedure. This is
normal and can last as little as a few days and as long as a few weeks. Some pain
may occur when the fragments pass, which begins soon after treatment and may last
for up to four to eight weeks. Oral pain medication and drinking lots of water will help
relieve symptoms.
It is important that you strain your urine following the procedure
(urinate through a mesh material that will collect any non-liquid
substance). This will help confirm that the remaining pieces of stone
have passed. You should give these pieces to your doctor. They
can help him or her determine the exact make-up of the stone.

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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Knowing what the stone is made of will help you and your doctor understand what
caused the stones and how to prevent stones from developing in the future.
After determining what the stones make-up is, the urologist may suggest:
drinking a lot of water, in some cases as many as 14 cups a day,
participating in physical activity, such as walking, and
lowering the salt and animal protein content of your diet.

The urologist may also prescribe medications. The type of medication
the urologist prescribes depends on the kind of stone passed, so it is
important that you retain a sample of the stone and give it to the
doctor.
Summary
Kidney stones can be very painful. Fortunately, they are treatable and preventable. If
the stone is not passed spontaneously and after taking medications, your doctor may
recommend ESWL.
ESWL is the least invasive procedure to remove kidney stones. It is also a very safe
and effective way to get rid of painful stones.
During ESWL, the doctor breaks down the stone with shock
waves. No incisions are done and no instruments are
inserted into the body. The waves, also called sound waves,
turn the stone to sand, which is then passed out of the
body easily with urine.
Like any procedure, ESWL has risks. Though these risks are
rare, knowing about them may help you find them and treat
them earlier.

This document for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a
recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the
advice of a doctor or a healthcare professional for your specific condition.

1995-2010 The Patient Education Institute, Inc. www.X-Plain.com ur080103
Last reviewed: 11/21/2009
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