Kidney Stone: Shock Wave Treatment (Lithotripsy)

What is shock wave treatment for kidney stones?

Shock waves from a lithotripsy machine are a way to break up kidney stones into smaller pieces. The pieces of stone are then flushed out of the body in the urine.

A kidney stone is a solid piece of material that forms in your urinary system. The stones are formed from substances in the urine. You can get a stone in any part of the urinary tract, including the kidneys, ureters, bladder, and urethra. Stones may be small or large. You may have just 1 stone or many stones.

The kidneys are inside your belly, on either side of your spine just above your waist. They make urine by taking waste products and extra salt and water from the blood. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder holds your urine until you urinate, and the urethra is the tube that drains urine from the bladder.

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, damaging the kidney, or blocking the flow of urine to the bladder.

The treatment 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.

Instead of this procedure, other treatments may include:

• Drinking lots of liquids and taking pain medicine. The kidney stone may pass on its own, especially if it is small.
• Breaking up the stone with ultrasound or a laser.
• Having surgery to remove the stones.
  • One type of surgery uses a thin, lighted, usually flexible tube inserted into the urinary tract through the urethra. Tiny tools can be passed through the scope to remove stones.
  • Another type requires a small cut in your back. A lighted tube and tools to remove the stone are inserted through the cut.

Your healthcare provider may recommend a different type of treatment 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 type of stone called 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.

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any other instructions your healthcare provider gives you.

What happens during the procedure?

This procedure is usually done in a surgical center or at the hospital.

Usually you will be given general anesthesia to keep you from feeling pain. General anesthesia relaxes your muscles and you will be asleep.

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 a tube that carries urine from the kidney to the bladder.

You will lie on a table over the lithotripsy machine. The lithotripsy machine will send shock waves against the kidney stones to break them. Your healthcare provider will use X-rays to find the kidney stones, keep the shock waves focused on them, and track their breakdown. The stones can then pass out of your body after a few days.

This procedure usually takes about 1 hour.

What happens after the procedure?

After the procedure you may stay in a recovery area for a few hours and then go home.

You may have 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 keep from getting more stones.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid and when you can return to your normal activities
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• You may have infection, bleeding, or blood clots.
• 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.
• Some of the broken kidney stones could irritate the bladder or ureter or block the ureter.
• There is a small risk that the procedure will not result in clearing the stone or stone pieces.
• On rare occasions there could be serious complications, such as shock.

There is risk with every treatment or procedure. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.