Extracorporeal shock wave lithotripsy, or ESWL for short, is a safe, minimally invasive and effective procedure for the treatment of kidney stones up to a maximum of 2 cm in diameter and ureteral stones up to a maximum of 1 cm in diameter. If desired, larger concretions can also be treated using ESWL after securing the urinary drainage (ureteral stent = DJ). This treatment method is suitable for most concrement localizations.
In the past, patients with urinary or kidney stones had to undergo surgery. Thanks to ESWL, it is now possible to treat urinary or kidney stones non-invasively. This means that the treatment is purely external. Surgery or the insertion of devices or catheters into the body is no longer necessary. General anesthesia is also no longer necessary. Whether ESWL makes sense depends primarily on the size of the urinary stones.
Today, modern devices known as lithotripters are used for ESWL . The first devices of this type looked like a bathtub in which the patient lay. Today they look like X-ray machines.
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Modern ultrasound lithotripter @ Dario Lo Presti / AdobeStock
The treatment itself, namely the transmission of the shock waves that break up the urinary calculus, is carried out via the coupling bellows. The coupling bellows rests on the shock wave generator and is filled with liquid.
The doctor then applies a gel containing water to the surface of the coupling bellows and to the patient's skin. The gel ensures that the shock waves are transmitted to the patient without any problems. Depending on where the stone is located, the doctor treats either the front or the back of the body. Bladder stones are also successfully treated in this way.
The latest devices detect the exact location of the stones using ultrasound or radiological localization. Thanks to the new option of "pulsed fluoroscopy", significantly smaller stones can now be detected and broken up.
The lithotripter generates acoustic shock waves. The coupling bellows transmits these into the patient's body. The shock waves exert tensile and shear forces on the stone and break it up. Patients excrete the remains of the stone in their urine.
Newer devices can penetrate deeper into the body. Treatment is therefore also possible for obese patients (over 200 kg). No surgery is necessary.
Technological advances in this field mean that ever larger stones can be removed. The more modern the equipment, the fewer the side effects.
There are various systems worldwide for breaking up stones in the body (using sound waves, water pressure or magnetism). The information gathered shows that the system using magnetism is the most effective, as it generates more energy.
The new devices are also suitable for treating children.
Before ESWL, the patient is given an analgesic (diclofenac, paracetamol, etc.) and, if desired, a sedative.
ESWL is generally very safe and has only minor side effects:
A common side effect is temporary blockage of the ureter by stone fragments. For this reason, the doctor usually inserts a catheter (double-J catheter) into the ureter beforehand in the case of larger stones (between 1 and 1.5 cm).
It is very common for the patient to see blood in the urine for a few days after the treatment. This is caused by small injuries to the mucous membrane. This is not usually serious.
A rare and serious complication is urinary tract infection (urosepsis). It occurs in less than 1% of cases. This is caused by urinary tract infections that were already present before the therapy but were not treated with antibiotics.
In some cases, a hematoma develops on the kidney. This can also be treated without surgery.
Follow-up treatment is not usually necessary. You can have the recommended check-up with your local urologist. If the treatment was not successful, a repeat ESWL can be performed.
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