Extracorporeal Shock Wave Lithotripsy (ESWL)
Extracorporeal Shock Wave Lithotripsy (ESWL) is a good option for patients who prefer a non-surgical approach and is especially effective for stones smaller than 2 cm in diameter
What are kidney stones?
Kidney stones are like the small gravel you find on the street, on the roadside. The similar things form within the urinary tract, and they can be in the kidney or anywhere else in the tract. They are usually made of calcium in 90% of cases, and in 10% of cases, they are made up of uric acid.
Calcium stones are generally hard stones that can be easily seen on a simple X-ray. Uric acid stones are softer stones and will not be seen on an X-ray but can be detected on an ultrasound or a CT scan. In modern societies, 90% of the stones are 1 cm or less in size because patients have more access to health care and investigations are done more often to detect stones before they cause any complaints.
In developing and underdeveloped countries, where access to health care may not be so easy, sometimes stones are found that have reached very large sizes and can be much more than 1 cm in size.
How do we treat stones that are 1 cm or smaller in size?
In general, stones that are less than 5 mm in size can be treated well with just hydration. Hydration involves drinking sufficient water so that the urine is colourless or very pale yellow in color. The amount of water you drink depends on your amount of urine. Typically, you have to hydrate yourself sufficiently so that the urine is fairly colourless.
In addition to that, there are medications available that may help to expel these stones. Stones 6 mm or larger, up to 1 cm in size, can be treated very well without any invasive procedure. This procedure is called ESWL or extracorporeal shock wave lithotripsy.
ESWL or extracorporeal shock wave lithotripsy
The procedure is simple. It can be done as an outpatient procedure, and the patient does not lose any time from work. It involves lying down on the machine, and with the help of X-ray and ultrasound, the stone is brought into focus. Electromagnetic waves, or what we call shock waves, are focused onto the stone, and the stone shatters into very tiny pieces and powder and is passed easily by the patient.
The only side effect is that sometimes there may be little blood in the urine one or two times when the patient urinates. The success rate of this treatment, when the stone is in the kidney, exceeds 90%. In a few percentage of patients, a second session of treatment may be required.
In other words, the patient has nothing to lose by going through this procedure, as it is extremely safe. The only contraindication to this procedure is if the patient is pregnant or if the stone is blocking the urinary passage and causing infection.
Can this procedure be used in the tube coming out from the kidney and going to the bladder?
This tube is called the ureter. When stones enter the ureter, they can be painful because of the blocking of the urinary tract. But they can also be treated by ESWL (extracorporeal shock wave lithotripsy) , although the success rates are lower, in the range of 80%.
As long as the stone can be localized by an x-ray or ultrasound, there is still a role for non-invasive treatment of these stones. Nowadays, worldwide, for some reason, most urologists tend to opt for invasive procedures like ureteroscopy and placement of stents for treating such stones.
In my opinion, the only indication for doing this procedure is the cost is higher when you do an invasive procedure. Unfortunately, the comfort of the patient is lower because the stent placed in the urinary system after such procedures can cause varying degrees of discomfort to the patient.
Also, these procedures need to be done under anaesthesia, and the patient may have to take 3 to 5 days off from work.
Can ESWL be used for stones larger than 1 cm?
When stones larger than 1 cm are treated by extracorporeal shock wave lithotripsy (ESWL), sometimes the number of fragments that are formed may be so large that they may obstruct the kidney and pain. It can still be done for stones up to 2 cm, provided the patient accepts the fact that a stent has to be placed while doing this procedure.
Unfortunately, in modern urology, in most centres, the ESWL machine lies unused, and this is purely, I feel, due to financial reasons. Revenue generation is less, and that seems to be the priority very often.
In summary, there are ways and means to treat stones 1 cm or less with maximum comfort to the patient by the procedure of ESWL.
If you’d like to learn more about ESWL treatment in Dubai or the UAE, feel free to reach out to Al Zahra Hospital or stop by for a visit! They’ll be happy to help you with any questions you have.
