Learn About Extracorporeal Shock Wave Lithotripsy

An example of why Extracorporeal Shock Wave Lithotripsy is needed.

By Dr. Jerry Yuan, M.D.

Extracorporeal Shock Wave lithotripsy, or ESWL, has revolutionized kidney stone treatment since its introduction in the mid-1980s. Now, it’s the most commonly employed treatment for kidney stones in the US.

Learn more about this treatment Georgia Urology is proud to offer for our patients below.

What is Extracorporeal Shock Wave Lithotripsy?

The inspiration of ESWL derived from aeronautical science, where the shock wave at the leading edge of airplane wings at high speed was studied. In short, with ESWL, a source of shock wave (electromagnetic, as in our Dornier device) is focused and directed at the stone. Various physical forces are then optimized to induce stone fragmentation with the goal of reducing sizable stone to smaller entities to allow for spontaneous passage. Refinements over the last 30 years allow the current generation of lithotripters to precisely focus the shock wave energy and minimize unintended collateral injury.

When Would Someone Receive Extracorporeal Shock Wave Lithotripsy?

Most kidney stones maybe considered for ESWL. A typically patient is one who has a medium size stone in the ureter tube and is deemed unlikely to pass expeditiously as seen in the 1st radiograph.

How Does Extracorporeal Shock Wave Lithotripsy Work?

Usually, a patient is scheduled as an outpatient and is positioned on the treatment table under light general anesthesia.

Our office preparing patient for Extracorporeal Shock Wave Lithotripsy.

General anesthesia is recommended given the procedure is somewhat painful. Additionally, since precise shock wave delivery is paramount, patient movements as those under twilight anesthesia tend to compromise the overall success. The stone is then localized and positioned in the “crosshair” prior to initiation of treatment and will be monitored throughout the session.

An xray for an example of crosshair of Extracorporeal Shock Wave Lithotripsy.

What Should be Considered Before Receiving Extracorporeal Shock Wave Lithotripsy?

Large stones greater than 1 cm, especially the rather hard stones, may require multiple sessions. This is. Because the energy required for these stones surpasses the amount the body can tolerate at a single session. Large and difficult to break stones may be more expediently treated by surgical stone removal whereby an endoscopic portal is introduced via the flank to allow for direct visualization and stone fragmentation and removal (PCNL).

Stones located in the lower ureter may also be treated via mini endoscopes via the urethra for direct basket removal or laser lithotripsy with high success rate.

A patient about to receive Extracorporeal Shock Wave Lithotripsy.

ESWL is one of several modalities at our disposal to allow for effective stone treatment. Each treatment has its pros, cons, and limitations. The best approach is by no means universal and is individually based taking into many factors such as size, location, chemical makeup or hardness, and patient preference. If you have any questions about this procedure, contact the urology experts at Georgia Urology.