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for more information about kidney stone disease.
The introduction of ESWL in the early 1980s revolutionized
the treatment of patients with kidney stone disease. Patients who
once required major surgery to remove their stones could be treated
with ESWL, and not even require an incision. As such, ESWL is the
only non-invasive treatment for kidney stones, meaning no incision
or internal telescopic device is required.
ESWL involves the administration of a series of
shock waves to the targeted stone. The shock waves, which are generated
by a machine called a lithotripter, are focused by x-ray onto the
kidney stone. The shock waves travel into the body, through skin
and tissue, reaching the stone where they break it into small fragments.
For several weeks following treatment, those small fragments are
passed out of the body in the urine.
In the two-plus decades since ESWL was first performed
in the United States, we have learned a great deal about how different
patients respond to this technology. It turns out that we can identify
some patients who will be unlikely to experience a successful outcome
following ESWL, whereas we may predict that other patients will
be more likely to clear their stones. Although many of these parameters
are beyond anyone’s control, such as the stone size and location
in the kidney, there are other maneuvers that can be done during
ESWL treatment that may positively influence the outcome of the
procedure. At the Brady Urological Institute, our surgeons have
researched techniques to make lithotripsy safer and more effective,
and we incorporate our own findings as well as those of other leading
groups to provide a truly state of the art treatment.
Advantages of ESWL
The primary advantage of ESWL is that it is completely
Who should be treated with ESWL?
ESWL is well suited to patients with small kidney stones that can
be easily seen by x-ray.
ESWL is NOT a particularly good treatment for:
Patients on “blood thinners” or patients with bleeding
disorders. Aspirin or other blood thinners must be discontinued
for at least 1 week prior to ESWL.
Patients with chronic kidney infection, as some fragments may
not pass, so the bacteria will not be completely eliminated from
Patients with obstruction or scar tissue in the ureter, which
may prevent stone fragments from passing.
Patients who require immediate and/or complete clearance of stone
Patients with stones composed of cystine and certain types of
calcium, as these stones do not fragment well with ESWL.
For directions to Johns Hopkins
PRIOR TO THE PROCEDURE
What to expect during you preoperative
During your initial consultation with your
surgeon, he will review your medical history as well as any
outside reports, records, and outside Xray films (e.g. CT
scan, MRI, sonogram). A brief physical examination will also
be performed at the time of your visit. If your surgeon determines
that you are a candidate for this procedure, you will then
meet with a Patient Service Surgery Coordinator to arrange
for the date of your procedure.
NOTE: It is very important
that you gather and bring all of your Xray films and reports
to your initial consultation with your surgeon.
What to expect prior to the procedure
Since insurance companies will not permit patients to be admitted
to the hospital the day before surgery to have tests completed,
you must make an appointment to have pre-operative testing
done at your family doctor or primary care physician's office
within 1 month prior to the date of surgery.
For Johns Hopkins Hospital Patients: These
results need to be faxed by your doctor's office to the Pre-operative
Evaluation Center at 443-287-9358
two weeks prior to your surgery. Please call The Documentation
Center at 410-955-9453
two weeks before your surgery date to confirm that this information
Once your surgical date is secured, you will receive a form
along with a letter of explanation to take to your primary
care physician or family doctor in order to have the following
pre-operative testing done prior to your surgery.
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood
for the procedure
Medications to Avoid Prior to Surgery
Aspirin, Motrin, Ibuprofen,
Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox,
Celebrex, Voltaren, Vioxx, Plavix and some other arthritis
medications can cause bleeding and should be avoided
1 week prior to the date of surgery (Please contact
your surgeon’s office if you are unsure about which
medications to stop prior to surgery. Do not stop any medication
without contacting the prescribing doctor to get their approval).
It is very important that your last urine
culture was negative prior to having this procedure. Please
call the physician’s office at least one week before
this procedure to confirm your urine culture results. If you
suspect that you may have a urinary tract infection, please
call the physician office immediately so that proper antibiotics
can be prescribed before your surgery.
Because ESWL is a completely non-invasive
therapy, most ESWL treatments are performed on an outpatient
Although the use of anesthesia does depend
on patient and physician preference, recent data suggest that
the results of ESWL may be improved with the administration
of a mild anesthetic.
When the patient has been adequately anesthetized,
a computerized x-ray machine is used to pinpoint the location
of the stone within the kidney. A series of shock waves (several
hundred to two thousand) is administered to the stone. Our
treatment protocols incorporate the latest research findings
which suggest that adjustments of both the shock wave power
and the rate at which the shock waves are delivered can affect
treatment outcome. Our goal when performing ESWL is to maximize
the breakage of a patient’s kidney stone while minimizing
injury that the shock waves can cause to the kidney and surrounding
Typically, an ESWL procedure lasts
for approximately one hour.
WHAT TO EXPECT AFTER
- Pain: Most patients
experience some degree of discomfort for a day or two after
ESWL. The pain is usually described as a dull ache over
the kidney, and is typically at its worst the evening following
surgery. The pain lessens over the following days.
- Bleeding: It
is normal to see blood in the urine for several weeks after
- How do I know if ESWL was
Several weeks following ESWL treatment,
your urologist will perform a follow-up x-ray, to determine
if the stone broke up into small pieces, and if those
small pieces passed out of the kidney. If the stone has
broken up into small fragments, but the fragments have
not cleared, the x-rays may be repeated again following
another several weeks.
If the stone has not broken up into small fragments, your
urologist will likely recommend further treatment. In
most cases, if the stone does not break up following one
ESWL treatment, more ESWL treatments are unlikely to be
successful. In this situation, other treatments, such
as ureteroscopy or percutaneous nephrolithotomy, may be
WHEN TO CALL YOUR
|Although ESWL is a safe
treatment, it is important to note that adverse events, although
uncommon, do occur. You should contact your doctor if any of
the following occur:
- Increasing pain, or pain that is getting
worse instead of getting better. This may indicate either
that there is bleeding around the kidney as a result of
ESWL or that the kidney stone fragments have all fallen
into the ureter and are blocking the drainage of urine from
- Large amounts of blood or blood clots
in the urine, which may indicate that the kidney was injured
by ESWL treatment.
- Fever, which may indicate that there
is a serious kidney infection.