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ESWL is a non-invasive medical procedure that uses a lithotripter to emit electrical impulses to break up kidney and gallstones. The patient lies on a machine bed and is given a sedative. The treatment does not destroy the stone, but it breaks it into small pieces that are expected to pass through the urinary tract within several days to weeks. Not all patients are candidates for ESWL.
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive medical procedure designed to help eliminate kidney and gallstones, otherwise known as kidney stones and gallbladder stones, respectively. The procedure is generally painless and usually conducted as an outpatient procedure without the need for anesthesia. However, ESWL patients are often given a sedative, most likely for the simple reason that the procedure can take up to an hour to complete and the recipient must remain reasonably still. In some cases, the patient is kept busy by being able to observe the entire process on an ultrasound monitor.
ESWL is achieved through the use of a lithotripter, a device that emits electrical impulses (shock waves) initiated by an electro-hydraulic, piezoelectric or electromagnetic generator. The first lithotripter introduced in the United States was the electro-hydraulic Dornier HM3 in the early 1980s, originally designed to test supersonic aircraft components. Its design is still considered the most reliable in terms of achieving optimal results. The latest generation of lithotripters use an electromagnetic generator, which delivers high-intensity pulses comparable to its predecessor, but with a much narrower focus.
During ESWL treatment, the patient lies down on the machine bed, which has a water-filled back support placed behind the kidneys. Using X-rays or ultrasound imaging, the technician pinpoints the location of the stone or stones. Once targeted, a series of low-grade pulses are generated followed by intermittent periods of rest to allow the patient to acclimate to the sensations of the shock wave, which are sometimes described as snapping with a taut rubber band. However, these sensations may be more intense if the stone is near a bone, such as a rib. Slowly, shock wave levels are increased to a high frequency and a rate of up to 120 pulses per minute.
This treatment does not destroy the stone. However, the stone will be affected by shear stress, causing it to break into small pieces. While this event signals the end of ESWL treatment, it is not the end of therapy for the patient. Within several days to weeks, small fragments of stones are expected to pass through the urinary tract. To facilitate this process and minimize discomfort, a ureteral stent is sometimes placed to allow for easier transit and passage through the ureter.
Not all patients with kidney or gallbladder stones are candidates for ESWL. First, it cannot be used if the patient is pregnant, has a pacemaker or has kidney cancer. It should also be noted that this treatment is usually ineffective against kidney stones linked to a genetic disease characterized by excessive levels of the amino acid cystine.
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