For starters, ESWL is noninvasive; extracorporeal means “outside the body.” So it’s not an invasive surgery, and you won’t have an incision.
The lithotripsy part means “the breaking of stones.” Dr. B-T will use fluoroscopy (x-rays) to locate the stone(s) and a machine called a lithotripter to target your kidney stone with soundwaves. The soundwaves break the stone into small particles that will pass with your urine.
You’re a candidate for ESWL if:
Unfortunately, kidney stones are rarely easy. Sure there are times when a patient has a very small stone that passes into the bladder and urinates it out. But that is far less common than the usual routine. The ESWL procedure tries to make passing the fragments as painless as possible, and as you can imagine, the smaller the fragments, the less the pain.
Kidney stones are all made within the kidneys and then at some point pass down the long tube called the ureter. The ureter is the tube that connects the kidneys to the bladder. Each kidney routinely has only one ureter. Some people can be born with two ureters per kidney, but this is rare and a topic for another day.
As the stones travel down the ureter, this is routinely where the pain starts. Think about a small pea traveling down a straw that opens and closes but then gets stuck in the straw. OK, that’s very similar to what happens to stones. So, the smaller the size of the pea fragments, the less pain involved.
ESWL is the least invasive approach, but in order for it to be successful, the patient needs to drink plenty of fluids afterward to pass the fragments. Occasionally, these fragments can get stuck in the ureter, causing more pain. The more fluids a patient drinks, the more the ureter stays open and the better chance for the fragments to pass into the bladder. Once in the bladder, the fragments will pass during normal urination.
Bladder stones are a completely different animal and primarily occur because the bladder can’t empty completely, not because the kidney stones get stuck in the bladder.
Besides ESWL, the other options include placing a ureteral stent, using a laser to destroy the stone, or placing a small hole through the back into the kidney (PCNL). Dr. B-T will discuss these options with you in more detail during your office visit, and his recommendations will depend on the location, size, and hardness of your stone(s).
The ureteral stent merely opens the ureter so urine and potentially stones and stone fragments can pass alongside the stent. Stents are routinely placed for patients who have a bad infection and the kidney needs help draining the urine, or because the stone(s) are larger and Dr. B-T is worried that the fragments could block the ureter.
Fortunately, unless the stent has already been placed prior to the ESWL, it is done under anesthesia at the time of your procedure. Ureteral stents are temporary and must be either removed or exchanged every four to six months to prevent calcifications building up like barnacles on a boat. Stents are routinely removed in the office as a two- to three-minute procedure.
ESWL is usually done as an outpatient procedure. Dr. Rich Bevan-Thomas will use general anesthesia to make you comfortable and because you must remain still throughout the procedure. During the procedure, you should not feel anything as you will be under anesthesia and happy as a clam at high tide.
You will lie on a procedure table with a cushion of warm water under you. The lithotripter will be positioned on your body over the region of the stone and will direct a series of soundwaves to the precise location.
Dr. Rich Bevan-Thomas only uses the Dornier 3 currently, which has excellent results in breaking kidney stones. In some cases, Dr. Rich Bevan-Thomas will insert a stent. A stent is a thin, flexible tube that is inserted to hold a ureter open (see above).
Following your procedure, you will probably spend a few hours in recovery before being sent home the same day.
