External Shock Wave Lithotripsy for Kidney Stone Treatment
Dr. Tony Nimeh is proud to offer the latest, most minimally invasive options for management of stones within the kidney and ureter, which is the tube connecting the kidney and bladder. We use the latest generation shock wave lithotripsy equipment to remove kidney and ureteral stones. Once upon a time, this required major surgery or incisions. The newest technology allows us to usually perform these cases in one hour or less, and on an outpatient basis.
What is extracorporeal shock wave lithotripsy (ESWL)?
Basically, this is the principle of energy sent as waves to break up kidney stones. Think of the waves generated from tossing a stone into still water, and this is the basic idea behind ESWL.
Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks.
Because of possible discomfort caused by the shock waves and the need to control breathing during the procedure, some form of anesthesia is often needed. SWL does not work well on hard stones, such as cystine, some types of calcium oxalate and calcium phosphate stones, or very large stones.
With SWL, you may go home the same day as the procedure. You may be able to resume normal activities in two to three days. You may also be given a strainer to collect the stone pieces as they pass. These pieces will be sent to the laboratory to be tested.
Although SWL is widely used and considered very safe, it can still cause side effects. You may have blood in your urine for a few days after treatment. Most stone pieces pass painlessly. Larger pieces may get stuck in the ureter, causing pain and needing other removal procedures.
Some of our patients come via the emergency room and arrive in severe pain. Usually these stones are lodged in the tube connecting the kidney and bladder. The resulting blockage causes dilation, or backup of urine in the kidney, causing pain. The ureter, which is a muscular tube, has contractions, as it’s trying to move the stone towards the bladder. This results in waves of pain, followed by relatively pain-free episodes. For other patients who are a bit more lucky we are able to locate the stone before it begins it’s journey down the ureter. Although most patients can pass a stone less than 4 millimeters on their own, any bigger than that, and the stone is likely to get lodged, causing trouble.
When appropriate, we will give pain medicine, including ToradolⓇ, which also relaxes the ureter, decreasing pain. We also use medications called alpha-blockers such as UroxatralⓇ, FlomaxⓇ, and RapafloⓇ, which can potentially dilate the ureter, allowing urine to be able to pass by the stone, reducing pain. In some lucky cases, the ureter dilates enough to pass the stone spontaneously and no surgery is needed.
For others with a larger stone, complex anatomy, or other factors such as urinary infection or severe pain, shock wave lithotripsy will be necessary to remove the stone.
When at all possible, we ask that you remain on a clear liquid diet the day before the procedure (soups, broths, etc.). This clears the bowels, and makes it easier to detect the stone under X-ray when there is less gas and stool in the abdomen.
It is also critical that you stop any aspirin, CoumadinⓇ, PlavixⓇ, or other blood thinners one week before shock wave lithotripsy. Please call our office should you have any questions about this.
After the procedure, patients may have a variety of minor issues. Although many patients may do fine with no issues, some patients may experience minor, temporary issues such as noticing burning with urination, frequent urination, small clots or pink/red colored urine, or occasional discomfort that radiates from the kidney to the bladder. Again, these usually tend to be minor issues, and resolve within one to two days after the procedure.Occasionally, there may be minor bruising at the site of lithotripsy. This is a natural occurrence from the energy waves entering the body to break up the stone.
Advice after shock wave lithotripsy
Definitely rest up for a day or two after the procedure. Drink at least six to eight glasses of water, preferably with lemon as it helps to dissolve some small stones, to wash out your system. For pain, Advil®, Motrin®, or prescription Toradol® work great, dependent upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are nonnarcotic, so you don’t get sleepy, constipated or have other issues; however they are great anti-inflammatories. Take them on a regular basis the first two to three days after the procedure. For pain not relieved by these medications, use the prescription Tylenol® with codeine or Vicodin® that was prescribed for you.
Usually, Dr. Nimeh or his staff will communicate to you a desired follow-up time frame. Please call us the day after the procedure to verify a time to see us in the office. Usually if there are stone fragments, we will have a stone analysis performed. We will also want to check an X-ray of the abdomen to make sure all stones were removed. Finally, Dr. Nimeh prides himself on both keeping their patients out of the operating room and reducing the chance of further kidney stones. This includes review of your diet to reduce kidney stones, 24-hour in-depth urine studies, and blood panels to find the cause and source of your stones. For most people, dietary and lifestyle changes will drastically reduce the chance of stones, while others may need the addition of medicines to help reduce stone formation.