Principles of the Procedure
Extrcorporeal Shock Wave Lithotripsy (ESWL) involves the use of focussed ultrasound shock waves to fragment either kidney or ureteric stones. Under a general anaesthetic, the stone is targeted with X-ray guidance and shock waves are then delivered to it through the skin and overlying tissues. There is no skin incision. The stone fragments then pass out in the urine.
Pre-Operative Preparation
You will generally be admitted on the day of the procedure. Depending on the position of the stone, a ureteric stent may be inserted at the time of ESWL or prior to it. An abdominal X-ray will need to be done within 48 hours of the ESWL to ensure that the stone can be seen and has not moved. A recent urine test should be performed (within 2 weeks of the ESWL) to ensure that you do not have a urine infection. No other specific preparation is needed apart from fasting from about 6 hours prior to the ESWL. You should continue to take your usual medications unless directed by your Urologist or his anaesthetist. Please inform us if you are taking any anticoagulant (blood thinning) medication or if you have a pacemaker or internal cardiac defibrillator.
Expected Post-Operative Recovery
Almost all patients are discharged home on the same day as the procedure. You should expect to pass small fragments of stones over the subsequent days to weeks. Occasionally the fragments may get ‘stuck’ in passing, with the symptoms of renal colic. This is managed by endoscopically, unblocking the stone fragments. Some blood staining of the urine can occur after you go home, though this almost always settles by keeping your oral intake of fluids up.
Occasionally, you may see some mild flank bruising – this is normal and is just the effect of the shock waves.
Risks – as per your discussion with your Urologist
Flank pain
Inability to pass fragments (‘steinstrasse’)
Bleeding
Urine or systemic infection
Need for repeat ESWL for complete stone fragmentation
Injury to the kidney
Anaesthetic risks