Extracorporeal shockwave lithotripsy (ESWL)
Published by Bupa's health information team, December 2008.
This factsheet is for people who are planning to have extracorporeal shockwave lithotripsy (ESWL) to treat kidney stones, or who would like information about it.
ESWL is a procedure that uses high-energy shockwaves to break down kidney stones into crystals small enough to be passed out in your urine.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.
- About ESWL
- What are the alternatives?
- Preparing for your procedure
- About the procedure
- What to expect afterwards
- Recovering from ESWL
- What are the risks?
- Further information
- Questions and answers
- Related topics
- Sources
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About ESWL
Extracorporeal shockwave lithotripsy (ESWL) is a procedure used to break down kidney stones.
Kidney stones are small, solid masses that form when salts or minerals normally found in urine become solid crystals inside the kidney. Usually, the crystals are very small and pass harmlessly out of your body. But if they build up inside your kidney, they can cause pain, infection and damage your kidney function.
Sometimes smaller kidney stones move out of the kidneys into the tubes that carry urine from your kidneys to the bladder (ureters). They can cause severe pain if they rub against or get stuck in the ureters.
The position of the kidneys and surrounding structures
What are the alternatives?
Depending on the size, density and position of the kidney stone, your doctor may recommend alternative treatment options.
- Ureteroscopy - if the stone is lodged in the ureter, a long narrow, flexible instrument called ureteroscope is used to remove it. This procedure is usually done under general anaesthesia and a laser may be used to break up the stone before flushing it out. Often a stent is left in the ureter to stop further blockage.
- Percutaneous nephrolithotomy (PCNL) - if the stone is large or in an awkward place, a fine instrument is passed through your back into the kidney to remove the stone. This procedure is usually done under general anaesthesia.
Preparing for your procedure
Your doctor will explain how to prepare for your procedure.
Lithotripsy is routinely done as an out-patient or day case procedure, without the need for anaesthesia. This means you have the procedure and go home the same day.
You can drink fluids as normal on the day of your procedure. But, you will need to go without food for four hours before your treatment.
If you normally take any medication (eg tablets for blood pressure), continue to take this as usual unless your doctor specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Your doctor will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
About the procedure
Lithotripsy takes about 20 to 30 minutes. Usually only one kidney is treated per session.
You will be asked to lie down on a couch. Ultrasound is used to pinpoint the exact position of the kidney stone(s). Gel is smeared on your skin to get good contact with the lithotripter sensor. The sensor focuses the shockwaves precisely onto each stone. The intensity of the shockwaves is increased gradually. Try not to make any movements during the treatment, otherwise the kidney stone may move out of focus.
Although the shockwaves don't hurt, you may feel an unusual and uncomfortable sensation as the stone is broken up.
What to expect afterwards
You will need pain relief to help with any discomfort. Your doctor will usually prescribe strong painkillers for the first 48 hours.
Your nurse will give you a date for a follow-up appointment and ask you to pass urine before you go home. It's best to have someone drive you home.
Recovering from ESWL
Continue to take your painkillers as directed by your doctor. Always read the patient information that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.
It's sensible to take it easy for the rest of the day. Most people feel able to resume normal activities on the following day.
Drink plenty of clear fluids over 48 hours to help flush the kidney stone fragments out of your urinary system.
Contact your GP if you develop any of the following symptoms as you may have developed a urinary tract infection (UTI):
- severe pain or pain that lasts for more than 48 hours
- high temperature
- burning sensation on passing urine or if your urine starts to smell
- heavy blood-stained urine
What are the risks?
Lithotripsy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects
These are the unwanted but mostly temporary effects of a successful treatment. Side-effects of lithotripsy include:
- pain and discomfort
- some blood and fragments of stone in urine
Complications
This is when problems occur during or after the treatment. Most people are not affected. Your doctor will be experienced at performing lithotripsy, but even so, there is a chance it may not be successfully completed and may need to be repeated.
Specific complications of lithotripsy are uncommon, but can include:
- infection - you may need antibiotics to treat this
- blockage of ureters - you may need surgery to unblock the tubes
- kidney damage - this can be permanent and affect your kidney function and blood pressure
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.
Further information
- National Kidney Federation (UK)
0845 6010209
www.kidney.org.uk - Kidney Research UK
0845 0707601
www.kidneyresearchuk.org
Extracorporeal shockwave lithotripsy (ESWL) Q&As
See our answers to common questions about extracorporeal shockwave lithotripsy (ESWL), including:
Related topics
Sources
- Webber R, Tolley D, Lingeman J. Kidney stones. BMJ Clinical Evidence, 2006. www.clinicalevidence.com, accessed 30 July 2008
- Grasso M. Extracorporeal shockwave lithotripsy. eMedicine. www.emedicine.com, accessed 30 July 2008
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: December 2008
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