Muljibhai Patel Urological Hospital
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Extracorporeal shockwave lithotripsy (ESWL)

Extracorporeal shockwave lithotripsy (ESWL)

Overview

ESWL is used to treat renal and ureteric stones non invasively. This treatment modality was developed in the early eighties in Germany by Dornier industry.

How it is done?

The lithotripter breaks the stone with minimal collateral damage to the surrounding soft tissue. The patient is well sedated and lies down on the apparatus bed with the coupling device at the level of the stone. Fluoroscopic and ultrasound imaging is used to localize and monitor stone fragmentation.

The sound waves generated by the generator is directed and focused on to the stone. The treatment usually starts at the lowest power level with a frequency of sixty shocks per minute and gradually moves to a higher level so that the stones are fragmented to sand like particles without damaging the kidney.

The procedure is stopped once the operator is satisfied with the level of fragmentation. We rarely give more than 1500 shocks in one sitting.

Risk

Sometimes the stone fragments may get stuck in the ureter blocking the passage of urine causing pain and fever. This may require hospital re-admission and removal of the stones from the ureter using a ureteroscope. ESWL is usually contraindicated if there is acute urinary tract infection, uncorrected bleeding disorders, uncorrected distal obstruction and pregnancy.

Prevention

Following the procedure most patients will have transient mild hematuria (blood in urine) lasting usually for one day.The patient is usually discharged home with the advice to drink plenty of fluids, with analgesics and antibiotics for 3 to 5 days. The passage of stones may take few days to weeks and may cause mild pain.