ESWL treatment table

Lithotripsy was first used in Germany in 1984 by Chaussy and colleagues. They used a Dornier HM3 lithotriptor which was very powerful and patients had to be given a general anaesthetic during treatment. As technology has advanced lithotriptors have changed and generally cause less pain and therefore treatments can be carried out with the patient awake although painkillers may have to be used during and after the procedure. Lithotripsy breaks the stone via shock waves which enter the body from outside.

The shock wave may be generated via 3 mechanisms i.e spark gap, electromagnetic, piezoelectric.

The shock wave is targeted onto the stone and the shockwave breaks the stone. Analgesia is usually given during the procedure.The stone will not pass immediately but over the next few days to weeks. Occassionally more than one treatment is required to break the stone. If the stone does not break with lithotripsy surgery may be necessary. Very small (less than 4mm) and very large stones (greater than 2cm) are usually not suitable for lithotripsy.

Shockwave treatment is a non invasive treatment for stones. It is not appropriate for all stones and your specialist will advise you whether this therapy is appropriate for you. The specialist will provide you with analgesia (pain killers) before and after the procedure if necessary. You will usually require an xray  / scan at a time decided by your specialist. Once your treatment is completed you will be able to return home the same day. You will normally require an xray after the treatment to see if your stone/s have broken successfully. Some patients with larger or harder stones may require more than one treatment. The success rate depends on the position, the stone composition and the stone size. Your specialist will provide you with more details regarding the success rates when he sees you.

If lithotripsy fails or is not appropriate as a first line treatment a surgical approach may be necessary.

As with all treatments there is always a risk of complications. These are listed below.

Common (greater than 1 in 10)
Bleeding on passing urine for a short period after the procedure
Pain in the kidney as small fragments of stone pass after treatment (20%)
Urinary tract infection due to bacteria released from the stone during
fragmentation, requiring antibiotic treatment (10%)
Bruising or blistering of the skin in the loin or on the front of the abdomen
Need for repeated ESWL treatments (15-20%)
Failure to fragment very hard stone(s) requiring an alternative treatment (less
than approximately 14%)

Occasional (between 1 in 10 and 1 in 50)
Severe infection requiring intravenous antibiotics (less than 1%) and
sometimes drainage of the kidney by a small drain placed through the
back into the kidney
Stone fragments occasionally get stuck in the tube between the kidney and
the bladder requiring hospital attendance and, occasionally, surgery to
remove the stone fragments

Rare (less than 1 in 50)
Kidney damage (bruising) or infection needing further treatment
Recurrence of stones (less than 1%)