Lithotripsy, also known as extracorporeal shockwave lithotripsy (ESWL), is a non-invasive procedure performed to break up kidney stones into small fragments using shockwaves, which allows them to be passed.
WHY IS ESWL REQUIRED?
ESWL can be used to break up kidney stones which are still in the kidney. This can prevent them from going on to cause pain and blockage of the kidney. ESWL is best for stones in the upper part of the kidney which are 5-20mm in size and can be seen on a plain X-ray.
ESWL can sometimes be used to break up stones which have started to move down the ureter (tube between the kidney and the bladder), including after a ureteric stent has been placed.
WHAT DOES ESWL INVOLVE?
ESWL is performed under general anaesthetic (completely asleep). It is a non-invasive procedure – there are no cuts made.
Xrays or ultrasound are used to locate the kidney stone. Shockwaves are passed through the skin of the back and focussed on the location of the stone. Up to 4000 shockwaves may be used in one session of ESWL.
The procedure is usually performed as day surgery – you can go home on the same day of the surgery as long as you are accompanied by a responsible adult.
WHAT IS THE RECOVERY AFTER ESWL?
You will have some soreness of the back and a graze where the shockwaves have passed through the skin.
Sometimes there will be some pain as the fragments of kidney stone pass from the kidney, down the ureter, into the bladder.
You will be given instructions for pain relief after the procedure. Usually regular paracetamol and/or ibuprofen for a few days is enough.
You may have some bleeding in the urine. This will clear up a few days after the procedure.
You may notice small fragments of kidney stone passing in the urine.
It is usually safe to drive 24 hours after the procedure.
You can usually return to work one to two days after the procedure.
WHAT ARE THE RISKS OF ESWL?
Specific risks of the procedure (excluding risks from the anaesthetic include):
Common (1/2 – 1/10)
- The stone may not break up completely or some fragments of the stone may not pass.
- Brusing, grazing or blistering of the skin of the back where the shockwaves have passed through.
Occasional (1/10 – 1/50)
- Larger stone fragments may block the ureter (the pipe between the kidney and the bladder), causing pain and sometimes requiring another procedure to correct.
- Infection in the urine.
- Developing an abnormal heart rhythm due to the shockwaves.
Very rare (< 1/250)
- Major trauma to the kidney causing bleeding, requiring another procedure to correct.
- Injury to a nearby organ such as the lung, liver, spleen or bowel, requiring another procedure to correct.
- A broken rib.
- Inflammation of the pancreas (pancreatitis).
WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?
- Conservative management of the stone – no surgery.
- Ureterocopy and laser lithotripsy – placing a small camera in through the urethra (the pipe you pass urine through) and up into the kidney and breaking up the stone with a laser.
- Percutaneous neprolithotomy – making a small cut in the back and passing a sheath directly into the kidney, through which a camera is placed. The stone can then be pulled out via the channel or broken up with a drill, ultrasound or laser.
WHERE CAN I FIND MORE INFORMATION ABOUT ESWL?
British Association of Urological Surgeons (BAUS): ESWL leaflet