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.

Medical Management of Kidney Stones

patient with kidney stones learning the best practice for the medical management of kidney stones

By Dr. Edan Y. Shapiro, M.D.

If you have questions about the medical management of kidney stones, you’re not alone. That’s why Georgia Urology’s Dr. Edan Shapiro is answering all your most pressing questions about the medical management of kidney stones.

What are Kidney Stones?

Kidney stones are one of the most common reasons for patient visits to our urology offices. In fact, one out of every 11 people will be affected by a kidney stone at some point in their lifetime. This represents a dramatic increase in the prevalence from just a few decades ago.

Additionally, stones can affect both men and women equally. Individuals with symptomatic stone pain often require visits to the emergency room and may even require a surgical procedure.

How Can I Prevent Them?

While the technologies to treat stones in a minimally invasive way are constantly evolving, perhaps an even more important focus has been on the medical management of stone disease. That is to say, how do we prevent stone formation in the first place? This is especially important considering that nearly ½ of people who get stones will have a recurrence.

Aside from the recommendation that all stone formers should drink at least 2.5 liters of fluid daily, there is no single dietary change or medicine to take that will improve every single person’s chance of getting a stone. This is despite some of the misinformation on the internet. Adding lemon juice or removing sweet tea from the diet may not help everyone!

Rather, it is important to determine the individual person’s risk profile, and then use that information to tailor a strategy. Make sure to ask your urologist about this.

What is a 24-hour Urine and Why Should I Consider Getting One?

Whenever a passed stone is available to test, it is a good idea to send that stone for analysis and determine its composition. But this represents only a small piece of the puzzle and often fails to tell the entire story. Perhaps more important is performing additional metabolic testing, which is recommended for any recurrent stone former, or even for the first-time stone former who is interested in minimizing their future risk.

This mainstay of this additional testing is a 24-hour urine collection, which is then analyzed for at least 10 different factors that are involved with stone formation. These factors collectively determine the patient’s risk and occasionally uncover an underlying systemic issue (such as a problem with the parathyroid gland or an issue with the kidney). By determining what factors are higher or lower than they should be, it is then possible to make recommendations to favorably alter those levels in a way that minimizes risk.

This is usually first attempted with diet modifications, though pharmacologic therapies also exist. For example, someone who is found to have high levels of calcium in their urine should be encouraged to limit their sodium intake; despite what many may assume, they do NOT need to alter their actual calcium intake. When this dietary change is not enough, certain types of pills can then be prescribed to further lower the level of calcium in the urine. Similar recommendations exist for people with other common scenarios, such as having elevated oxalate levels, elevated uric acid levels, or for people with low urinary citrate levels.

Will I be Able to Prevent all Stones?

Even the best of plans cannot be 100% foolproof. Therefore, it is important to repeat the 24-hour urine test after the implementation of a treatment strategy and then with some regularity. This way, the strategies can be constantly improved, setting up the person for success. It is also important to make sure to get periodic follow-up imaging (e.g. ultrasound, x-ray, CAT scans) to look for interval stone formation or growth.

If you have any more questions about the medical management of kidney stones for the Georgia Urology team, click here to schedule an appointment with any of our expert urologists.

Protecting Your Child’s Kidneys

By Dr. Hal Scherz, M.D., F.A.A.P., F.A.C.S.

Children may have the same kind of kidney problems that we find in adults, such as kidney stones, tumors, and infections.

Kidney problems in children are often difficult to detect because symptoms may not be present or the child is unable to communicate. Therefore, parents need to have a heightened awareness and index of suspicion regarding unusual findings.

Common Kidney Issues with Children

Children may have the same kind of kidney problems that we find in adults, such as kidney stones, tumors, and infections. However, the majority of issues in children are the result of problems that occur in the developing kidney prenatally. These problems can affect the kidney directly, such as an obstruction. It could also happen indirectly as a consequence of a problem elsewhere in the urinary tract, such as in the bladder with reflux or backflow up the ureter into the kidney. Some problems are unique to boys such as an obstruction in the urethra, while other problems are far more common in girls, such as reflux.

How to Catch Kidney Issues Early

Many problems are now detected prenatally thanks to the routine use of sonograms. Any child who has abnormal kidneys prenatally should have a repeat study after birth, but generally not before 1-2 weeks of age. Newborns are typically dehydrated from the trauma of birth and the actual degree of the problem may be underestimated if evaluated too soon.

Diagnosis Options

Any child with visible blood in the diaper or in the urine should be evaluated with an ultrasound of the kidneys. This is an excellent screening test and based on the result, further testing may be necessary. Their pediatrician should evaluate any child with a high fever that persists for more than several days. If there are not any obvious sources for the fever, a urinary tract infection should be suspected. The method of urine collection is important so that an accurate diagnosis can be made. It is always preferred that the urine specimen be obtained using a catheter. If the urine is infected, further testing is indicated after treatment.

Most kidney problems that are found in children are either repairable or treatable. However, problems that are developmental, should be discovered, evaluated, and addressed, sooner for a better the long-term outcome. If you suspect your child might be suffering from a kidney issue, call 888-503-1842 to schedule an appointment today.

What happens when you get kidney stones, but only have one kidney?

About 8.8 percent of the population in the U.S. will experience the pain of a kidney stone, according to a 2012 study published in European Urology. That adds up to about half a million people every year, or 1 in 10, and those numbers are rising, the National Kidney Foundation says.

But what happens if you were born with only one kidney or lost one to disease or trauma? How does that affect your diagnosis and treatment if you get a kidney stone?

What is a Kidney Stone?

A kidney stone is a solid mass that forms from elements in urine. Most are very small and pass through unnoticed. Some, however, are large enough to get trapped, usually in the urinary tract. The result is blocked urinary flow and a lot of pain.

Symptoms of a kidney stone include:

  1. Severe side or back pain that may spread to the groin
  2. Pain that comes in waves and may intensify when you have to urinate
  3. Pink, red or brown urine
  4. Cloudy or foul-smelling urine
  5. Nausea
  6. Frequent urination or bladder pressure
  7. Difficulty urinating

The pain of a stone may seem to move around, as well.

How Having One Kidney Affects a Kidney Stone

The same things that cause a person with two kidneys to get stones can put a patient with just one at risk. For example, failing to drink enough water is a risk factor, as is obesity or a high protein diet.

When you have just one kidney, you do have to be careful not to damage it, though. If you have symptoms of a stone, see your doctor right away for a proper diagnosis. A person with kidney stones can develop chronic kidney disease that will affect the health of your remaining organ.

The doctor may want to take steps to help you pass the stone, such as using a noninvasive treatment to break it up. Having one stone increases your risk of more forming, too. You may need to change your diet or take medication to manage the condition.

The most important thing is not to ignore any sign that there is a problem with your kidney, whether it is a stone or not. People with one working kidney need a function check at least once a year.

If you think you could be at risk for kidney stones, please contact Georgia Urology today to schedule an appointment and learn more about your treatment options.