Lithotripsy for Kidney Stones

What is lithotripsy for kidney stones?

Lithotripsy for kidney stones is a procedure that uses shock waves from a lithotripsy machine to break up stones in the kidney. The stone pieces are then flushed out in the urine. The full name for this procedure is extracorporeal shock wave lithotripsy, or ESWL.

When is it used?

ESWL may be done when stones in the kidney are painful, are damaging the kidney, or are blocking the flow of urine to the bladder.

The treatment of kidney stones depends on how big the stones are, where they are, and what they are made of. Many kidney stones pass out of the body without treatment. Some stones that do not pass on their own can be treated with lithotripsy.

An alternative treatment is to have the kidney stones removed surgically. Or you could choose not to have treatment, recognizing the risks of your problem. You should ask your healthcare provider about these choices.

You should not have lithotripsy if:

• You are pregnant.
• You have serious problems with your heartbeat, such as arrhythmia (a fast or irregular heartbeat that cannot be controlled or is controlled with a pacemaker)
• You take blood thinners to prevent blood clots.
• You have a very large stone (more than 1 inch, or 2.5 centimeters, in diameter).
• Your kidneys don’t work well.
• You have a uric acid or cystine stone.
• The stones are in a part of the kidney where it would be hard for the pieces of stone to pass.

How do I prepare for ESWL?

Plan for your care and recovery after the procedure. Allow for time to rest and try to find people to help you with your day-to-day duties. You should arrange for someone to drive you home after the procedure.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly and are more likely to have breathing problems during a procedure. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before the procedure.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your procedure. If you are taking a blood thinner, such as warfarin (Coumadin), your provider will tell you when you need to stop taking it before the procedure.

Follow any other instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a sedative or general anesthetic. A sedative helps you relax and may put you to sleep. A general anesthetic will relax your muscles, puts you in a deep sleep, and prevents you from feeling pain. Your provider may think that a sedative is all you need. You will likely recover more quickly from a sedative than from a general anesthetic.

Your provider may put a tube called a stent into your ureter before the procedure to help the pieces of stone pass. The ureter is the tube connecting the kidney to the bladder.

You lie on a table over the lithotripsy machine. The lithotripsy machine sends shock waves against the kidney stones, breaking them. Your healthcare provider uses X-rays to find the kidney stones, keep the shock waves focused on them, and track their breakdown. The stones can then pass down your ureter, into the bladder, and out of your body after a few days.

What happens after the procedure?

You may be in the recovery room for a few hours to recover from the anesthetic before going home. You may keep having pain after the procedure as the pieces of stone pass out of the ureter into the bladder. You may be given medicine for this pain after the procedure. Drink a lot of fluids to help keep stones from reforming and to flush out the remaining pieces of stone. Follow your provider's instructions for straining your urine to collect all stone fragments.

If you had a stent put in your ureter, your provider may take it out in 3 to 10 days. During that time you may need to go to the bathroom more often than usual. It is very common, especially if a stent is used, to have blood in your urine. This may last for several days after the procedure.

For a few days you may have bruising and minor discomfort in the back or abdomen from the shock waves.

You may be given medicine to prevent stones from reforming. Ask your healthcare provider how you should care for yourself at home and when you should come back for a checkup.

What are the benefits of this procedure?

You may be rid of the kidney stones and the problems they might cause without surgery.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• There is a very small risk of damage to the kidney or development of high blood pressure when a stone in the kidney is treated. However, usually the risk of NOT treating a stone is much greater than the risk of treatment itself.
• There is a risk of infection or bleeding.
• Some of the broken kidney stones could irritate the bladder or ureter or block the ureter.
• There is a small risk you may need another procedure if a blockage occurs or if pieces of stone remain in the kidneys or ureters.
• On rare occasions there could be serious complications such as shock.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever.
• You have increasing pain.
• You cannot urinate.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.