How to Prepare for Extracorporeal Shock Wave Lithotripsy

Preparing for Extracorporeal Shock Wave Lithotripsy (ESWL) involves important steps to ensure a safe and effective procedure for breaking up kidney stones. You will typically need to discuss your medications with your doctor, stop certain drugs like blood thinners, fast before the procedure, and arrange for someone to drive you home afterward. Following these instructions helps minimize risks and supports a smooth recovery.

What is Extracorporeal Shock Wave Lithotripsy?

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive medical procedure that uses high-energy sound waves to break kidney stones into smaller pieces. These smaller fragments can then pass more easily out of your body through your urine. It is a common treatment for kidney stones that are too large to pass on their own.

The goal of ESWL is to reduce the stone to fragments small enough to pass naturally when you urinate. This helps relieve the pain and potential complications that larger kidney stones can cause.

Why it's done

Extracorporeal Shock Wave Lithotripsy (ESWL) is performed to treat kidney stones that are causing symptoms or are too large to pass on their own. Stones can cause severe pain, block urine flow, or lead to infections. ESWL offers a way to break these stones into smaller, more manageable pieces.

The decision to perform ESWL is made after your doctor assesses the size, location, and type of your kidney stone, as well as your overall health. The aim is to prevent complications such as kidney damage or severe infection by removing the obstruction.

How to prepare

Preparing for Extracorporeal Shock Wave Lithotripsy (ESWL) involves several key steps to ensure your safety and the procedure's effectiveness. You will need to discuss all your medications with your doctor, stop certain drugs like blood thinners, fast for a specific period before the procedure, and arrange for someone to drive you home afterward.

Before your ESWL procedure, your doctor will review all medications, supplements, and herbal remedies you are taking. It is crucial to inform them about everything, especially blood thinners (anticoagulants), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. You will usually be instructed to stop taking these medications several days (often 5 to 7 days) before the procedure to reduce the risk of bleeding. You will also receive instructions about fasting. Typically, you will need to avoid eating or drinking anything after midnight the night before your procedure. This is important if you will receive anesthesia or sedation, as it helps prevent complications like aspiration (inhaling stomach contents) during the procedure. Because you will likely receive anesthesia or sedation, you will not be able to drive yourself home. It is essential to arrange for a responsible adult to pick you up and take you home after the procedure. You should also plan for someone to stay with you for the first 24 hours. Ask your healthcare team any questions you have about the procedure or recovery beforehand.

What happens during

During Extracorporeal Shock Wave Lithotripsy (ESWL), you will typically receive anesthesia or sedation to keep you comfortable. You will lie on a special table, and a machine called a lithotripter will deliver focused shock waves through your skin to break up the kidney stone. Your medical team will use imaging, like X-rays or ultrasound, to precisely target the stone.

You may hear a clicking sound during the procedure and might feel a tapping sensation or mild discomfort, even with anesthesia. The medical team will continuously monitor your vital signs and comfort level. The goal is to deliver enough shock waves to fragment the stone without causing undue discomfort or harm to surrounding tissues.

Recovery & timeline

After Extracorporeal Shock Wave Lithotripsy (ESWL), you will spend some time in a recovery area while the anesthesia wears off. Most people can go home the same day. You may experience some pain, blood in your urine, and bruising, and you will need to drink plenty of fluids to help pass the stone fragments over the next few days to weeks.

Immediately after the procedure, you will be monitored in a recovery room. You may feel groggy from the anesthesia and might experience some pain or discomfort in your back or side where the shock waves were delivered. Your doctor will prescribe pain medication to help manage this. It is common to see blood in your urine for several days after ESWL, which is a normal sign that stone fragments are passing. It is crucial to drink plenty of water and other fluids to help flush the stone fragments out of your urinary system. You may be given a strainer to collect any passed stone pieces, which can be sent for analysis to help prevent future stones. Bruising on your back or side is also common where the shock waves entered your body. Most people can return to light activities within a day or two, but strenuous exercise should be avoided for a few days to a week, as advised by your doctor. The timeline for passing all stone fragments can vary, ranging from a few days to several weeks. You will have a follow-up appointment with your doctor to check on your recovery and confirm that the stones have passed or are sufficiently fragmented.

Risks & side effects

While Extracorporeal Shock Wave Lithotripsy (ESWL) is generally safe, it carries some potential risks and side effects. Common temporary effects include pain, blood in the urine, and bruising. Less common but more serious risks can include infection, blockage of the ureter by stone fragments, or, rarely, kidney damage or high blood pressure.

After ESWL, it is very common to experience pain as the stone fragments pass through the urinary tract. You may also notice blood in your urine (hematuria) for several days, and bruising on the skin where the shock waves were applied. These are usually temporary and resolve on their own. Your doctor will provide pain relief medication to manage discomfort. Less common side effects include urinary tract infections, which may require antibiotics. Sometimes, a large number of stone fragments can block the ureter, creating a condition called "steinstrasse" (German for "stone street"). This may require additional procedures to clear the blockage. In rare cases, ESWL can cause bleeding around the kidney or, very rarely, lead to kidney damage or the development of high blood pressure (hypertension) in the long term. It is important to discuss all potential risks and benefits with your clinician before the procedure. They can help you understand the likelihood of these complications based on your specific health condition and the characteristics of your kidney stone.

Success rate

The success rate of Extracorporeal Shock Wave Lithotripsy (ESWL) varies, but many people successfully pass their kidney stones after the procedure. Success depends on factors like the stone's size, location, and composition. While a single treatment can be effective, some individuals may require multiple ESWL sessions or other treatments to become stone-free.

Research reviews, such as those found in the Cochrane Library, indicate that ESWL is effective for many kidney stones, particularly those up to 2 centimeters in size. Stone-free rates, meaning no remaining stone fragments, can range from about 50% to 90%, depending significantly on the stone's characteristics. Stones located in the lower part of the kidney may have slightly lower success rates compared to those in the upper or middle parts. Factors that can influence the success of ESWL include the hardness of the stone, its chemical composition, and the patient's body size. Larger or harder stones may be more resistant to fragmentation and might require more shock waves or multiple treatment sessions. It is not uncommon for about 1 in 3 people (30-40%) to need a second ESWL treatment to achieve optimal results. Even if the stone is not completely broken into tiny fragments, ESWL often reduces its size enough to make it easier to pass naturally or to be treated with other less invasive methods. Your doctor will monitor your progress with follow-up imaging to determine if further treatment is necessary.

Frequently asked questions

How long does it take to recover from ESWL?

Most people can go home the same day as their ESWL procedure. You can usually return to light activities within a day or two, but it's best to avoid strenuous exercise for about a week. The time it takes to pass all stone fragments can vary widely, from a few days to several weeks.

Will I feel pain during or after ESWL?

During ESWL, you will receive anesthesia or sedation, so you should not feel significant pain. Afterward, it is common to experience some pain or discomfort in your back or side as the stone fragments pass. Your doctor will prescribe pain medication to help manage this discomfort.

What should I drink after ESWL?

After ESWL, it is very important to drink plenty of fluids, especially water. This helps flush the broken stone fragments out of your urinary system and reduces the risk of new stone formation. Aim for at least 8-10 glasses of water per day, or as advised by your doctor.

Can I drive myself home after ESWL?

No, you cannot drive yourself home after ESWL. Because you will receive anesthesia or sedation, your judgment and reaction time will be impaired. You must arrange for a responsible adult to drive you home and ideally stay with you for the first 24 hours after the procedure.

Is it normal to see blood in my urine after ESWL?

Yes, it is very common and normal to see blood in your urine (hematuria) for several days after ESWL. This is a sign that the stone fragments are passing through your urinary tract. If the bleeding is heavy, persistent, or accompanied by severe pain or fever, contact your doctor.

What if the ESWL doesn't break up all the stones?

If ESWL does not completely break up all the stones, or if fragments are too large to pass, your doctor may recommend additional treatments. This could include another ESWL session, a different procedure like ureteroscopy, or medication. Your doctor will monitor your progress with follow-up imaging.

Sources

• MedlinePlus — How to Prepare for Extracorporeal Shock Wave Lithotripsy
• Mayo Clinic — How to Prepare for Extracorporeal Shock Wave Lithotripsy
• Cochrane Library — How to Prepare for Extracorporeal Shock Wave Lithotripsy