Extracorporeal shock wave lithotripsy (ESWL) is a safe, minimally invasive, and effective procedure for treating kidney stones up to 2 cm in diameter and ureteral stones up to 1 cm in diameter in cases of urolithiasis. Upon request, larger stones can also be treated with ESWL after ensuring unobstructed urine flow (ureteral stent = DJ). This treatment method is suitable for most stone locations.
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 noninvasively. This means that the treatment is performed entirely externally. Surgery or the insertion of devices or catheters into the body is no longer necessary. General anesthesia is also no longer required. The indication depends primarily on the size, location, and composition 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 resemble X-ray machines.
Modern ultrasound lithotripter @ Dario Lo Presti / AdobeStock
The treatment itself—namely, the transmission of shock waves that shatter the urinary stone—is carried out via the coupling bellows. The coupling bellows rests on the shock wave generator and is filled with fluid.
The doctor then applies a water-based gel 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 the stone’s location, the doctor treats either the front or the back of the body. Bladder stones are also successfully treated this way.
Localization Methods in Extracorporeal Shock Wave Lithotripsy (ESWL)
The latest devices detect the exact location of the stones using ultrasound or radiological imaging. Thanks to the new “pulsed fluoroscopy” technique, even significantly smaller stones can now be detected and碎裂.
How does extracorporeal shock wave lithotripsy (ESWL) work?
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, shattering it. Patients excrete the stone fragments in their urine.
Newer devices can penetrate deeper into the body. This makes treatment possible even for obese patients (over 200 kg). No surgery is required.
Technological advances in this field mean that increasingly larger stones can be removed. The more modern the devices, 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 available data show that the system using magnetism is the most effective, as it generates more energy.
The new devices are also suitable for treating children.
Medications During Extracorporeal Shock Wave Lithotripsy (ESWL)
Before ESWL, the patient receives a pain reliever (diclofenac, acetaminophen, or similar) and, if desired, a sedative.
Side Effects and Risks of ESWL
ESWL is generally very safe and has only minor side effects:
A common side effect is temporary blockage of the ureter caused by stone fragments. For this reason, the doctor usually inserts a catheter (double-J catheter) into the ureter beforehand when dealing with larger stones (between 1 and 1.5 cm).
It is very common for the patient to notice blood in the urine for a few days after treatment. This is caused by minor injuries to the mucous membrane and is usually nothing to worry about.
A rare and serious complication is a urinary tract infection (urosepsis). It occurs in less than 1% of cases. This is caused by urinary tract infections that were already present before treatment but were not treated with antibiotics.
In some cases, a hematoma may develop on the kidney. This, too, can be treated without surgery.
Follow-up Care & Checkup
Follow-up treatment is generally not necessary. You can have the recommended follow-up examination performed by your local urologist. If the treatment was not successful, another ESWL procedure can be performed.
FAQ
What is extracorporeal shock wave lithotripsy?
Extracorporeal shock wave lithotripsy is a urological procedure for breaking up kidney stones and ureteral stones using shock waves generated outside the body.
How are the stones located during treatment?
Before and during treatment, the stones are diagnosed and located using ultrasound or X-rays to ensure the shock waves are precisely directed at the stone.
How do the stone fragments leave the body?
After fragmentation, the resulting stone fragments are excreted through the urinary tract with the urine, usually naturally.
Is follow-up care necessary after treatment?
Special follow-up care is generally not required; however, a urological follow-up examination is recommended to assess the success of the treatment.
About the medical author
Dr. med. Andreas Neisius
Medical writer
