Kidney Stones
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Extracorporeal Shock Wave Lithotripsy (ESWL)
Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to break up urinary tract stones located within the kidney as well as the ureter. It is considered a non-invasive surgical procedure.
German engineers, at the Dornier Corporation, developed the original lithotripters in the early 1980's. The machines began to appear in the United States in about 1983. The original machines required that the patient partially submerged in a very large tub of water. This water coupling mechanism allowed for delivery of the shocks without the loss of power as they traveled from the site of origination to the stone. The newer machines use a water pillow.
Most if not all of these procedures are done on an outpatient basis. In our practice, we use machines located at the George Washington University Surgical Center, or at River Road Surgery Center.
General anesthesia, or heavy sedation is used to decrease the associated discomfort as well as to decrease patient movement and allow for better targeting. The average time for the procedure is about 45 minutes. In most instances, the procedure is completed with the patient merely lying over the shock wave generator. Up to 3000 shocks may be given. At various times, the progress will be monitored with fluoroscopy to make sure that the targeting is still accurate. In cases where the stone is large, impacted, or not seen well on x-ray, the surgeon may suggest that a stent be placed. This "double-J" or "pigtail" tube will allow for better visualization of the urinary tract as well as for easier passage of the fragments. The stent will be left in place for a length of time that varies from a day or two to a week, depending on the location, and size of the stone. The stent is removed in the office, or outpatient surgery center, under local anesthesia, or conscious sedation, if necessary.
Stone fragments will pass over a varied length of time from days to months. Please refer to our ESWL bullet document for more information.