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Stone Disease Management

Extra-Corporeal Shockwave Lithotripsy (ESWL)

ESWL is a method of breaking kidney stones by use of shockwaves. It allows for non-surgical and non-invasive pulverization of renal calculi after which the fragments are then passed.

The patient is connected to a lithotriptor (machine for breaking kidney stones) and positioned so that the stone is centered in the shock-wave focal point. The shock waves are generated in a portion of the lithotriptor resembling a large spark plug. The shock waves are transmitted in a water bath to the patient and focused onto the stone by x-ray control.

Usually 2400 shocks are required to fully fragment a renal calculus. The fragments are often small enough to pass easily. Stones that are 1.0cm in diameter and present in the kidney will fragment with one treatment 90% of the time. Kidney stones that are larger will not fragment as well. 10% of stones require a second ESWL.

The patient is given an intravenous sedative and positioned. The shocks are timed with the patients pulse. The stone begins to fragment after 300 shocks. The treatment is complete once the stone appears fragmented on an x-ray. Small particles are passed in the urine over the next several days.

Very large or "staghorn" calculi usually require multiple combined techniques. Percutaneous stone destruction is usually performed first to remove the majority of the stone or “debulking” it. Multiple ESWL treatments alone will usually not fragment and clear a staghorn calculus from the kidney.

Ureteral stones form in the kidney then pass into the ureter where they lodge causing severe pain. Four millimeter (4mm) stones, when located in the ureter, have a 90% spontaneous rate of passage. Four to Five point nine millimeter (4-5.9mm) stones have a 50% chance of passage in general. Six millimeter (6mm) stones will pass spontaneously only 20% of the time. Stones located in the upper ureter are much less likely to pass.

ESWL has an 85% success rate for the treatment of upper ureteral stones. It is 80% successful for the treatment of lower ureteral stones. Ureteroscopy for lower ureteral stones is 95% successful but it is more invasive. Open stone surgery is still required for the more difficult stones.

Preparation for ESWL: Stop all aspirin/Advil and aspirin type products one week before the scheduled ESWL. Take all your usual medications on the morning of the ESWL with a small amount of water. Do not eat breakfast or drink anything. Diabetics should not take their insulin or oral medication unless specifically told to do so.

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Understanding Kidney Stones (PDF, 11.4mb; requires Adobe Acrobat Reader to view.)