All of us know that kidney stones can be one of the most painful conditions people can go through. When it comes to treating kidney stones, there are alternative options out there. For one, Extracorporeal Shock Wave Lithotripsy treatment (ESWL) uses shock waves to non invasively shatter kidney stones into smaller pieces so they can be passed through the urinary tract.
Recently, we have come across some questions regarding which patients should undergo ESWL treatment. Let’s further discuss the Kidney Stone Cases in which ESWL Method is Helpful as compared to other procedures.
Understanding ESWL: How Does It Work?
The ESWL treatment applies powerful shock waves aimed externally at the kidney stones, minimizing the physical contact. Due to the high energy given to the stone, the shock waves should break the stone into smaller, more passable pieces. Some form of anesthetic is also necessary for the patient to avoid complications arising from excess pain.
Advantages of ESWL
- Non Invasive surgery technique.
- No cuts or operations to the body are required.
Most Suitable Cases for ESWL
Although ESWL is an option for many patients, it is more useful under certain circumstances. These are the main reasons which ESWL might be useful for a patient.
1. Size of the Stones
Kidney stones in the size between 4 mm to 20 mm in diameter is considered to be the most responsive to ESWL. Stones larger than these may not be shattered completely and achieve some degree of fragmentation, but will still require additional treatment sessions due to the need to clear the remaining fragments.
2. Location of the Stones
- Upper and Middle Kidney Stones: ESWL is far more likely to be effective on stones located in the upper and middle parts of the kidney, due to them getting better access from shock waves.
- Lower Pole Kidney Stones: These stones may be less responsive to treatment because fragments will be difficult to pass down the urinary tract due to gravity. However, in some cases, ESWL with certain postures and hydration level can work.
- Ureteral Stones: ESWL aims to treat hones stuck in the upper ureter close to the kidney and in turn, should be do able successfully.
3. Stone Composition
The type of kidney stones actually has a role in determining how effective ESWL will be.
- Calcium Oxalate & Calcium Phosphate Stones: The most commonly found stones, tend to be the one to respond well to ESWL procedures.
- Uric Acid Stones: These are often treated with medications intended to dissolve the stones, with some success.
- Cystine & Struvite Stones: These are tougher and more resistant to ESWL and often require alternative methods such as laser lithotripsy or PCNL.
4. Factors Related to the Patient
- Body Weight: In obese patients, ESWL may be less efficient because the shock waves may not adequately access the stone.
- Pregnancy: The procedure is not advisable in pregnant women since the application of shock waves may pose a risk to the fetus.
- Bleeding Disorders: Patients with clotting disorders, or those on anticoagulant therapy, must first stop medication in advance of ESWL because the shocks may induce excessive bleeding.
- Urinary Tract Infections: If a patient has an infection, it needs to be resolved before gently using shock waves.
5. Kidney Function
Ideal candidates for using ESRW are those with normal functioning kidneys.
Patients with impaired kidney function such as chronic kidney disease, need thorough assessment prior to considering ESRWL to prevent additional complications.
When is ESWL not recommended?
Even though ESWL is regarded as a straightforward and effective technique, it is not recommended for the following:-
- Stones larger than 2 cm, as these tend to require more invasive approaches like PCNL or ureteroscopy.
- Stones that are not easily fragmented by shock waves.
- Patients with certain forms of anatomical pathology highly complex, which inhibits the natural passage of stone fragments.
- In cases where the penetrability of shock waves is hampered.
Other methods of treating kidney stones
When ESWL is not viable, other treatment options include:-
- RIRS or Retrograde Intrarenal Surgery is a kidney stone minimally invasive surgical treatment that uses a flexible ureteroscope to laser fragment and remove the stones within the kidney.
- Ureteroscopy (URS): A minimally invasive technique of removing or fragmenting stones by laser through the urinary tract using a thin scope.
- Percutaneous Nephrolithotomy (PCNL): This approach is recommended when renal stones are greater than 2cm. It involves a small incision to the back to access and remove the stones directly from the kidney.
Recovery and Care after the Procedure
Following an ESWL session, the majority of patients will attest to feeling some degree of discomfort as the stone fragments are expelled through the urinary tract. Standard post-procedure recommendations include:
- Drinking a lot of water in order to help expelling the stone fragments.
- If some pain is felt, taking pain medication as prescribed.
- Straining the urine to capture stone fragments for analysis.
- Monitoring stone clearance by the doctor through follow-up consultations.
Talk to The Expert for Specialized Treatment
In the case of kidney stones, ESWL is a suitable alternative for a good number of patients; however, its efficacy is determined by the size, location, and composition of the stone. If you or someone you know suffers from kidney stones, it is essential to consult a professional urologist to assess the appropriate method of treatment for the condition.
Dr. Deepanshu Gupta is a prominent name regarding urology in Gurgaon. He has extensive experience in advanced kidney stone management, which includes ESWL, laser lithotripsy, and PCNL. He has specialized in advanced laparoscopic and robotic techniques which allow him to provide tailored care to all his patients. When it comes to urological problems in Gurgaon, he is the doctor to consult without a doubt.
Book an appointment today for a consultation and begin the journey to living a life free of kidney stones!