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EXTRACORPOREAL SHOCK WAVE LITHOTRISPSY
SWL is done with a machine that can break stones from outside the body. To break the stone, focused shock waves (short pulses of high energy sound waves) are transmitted to the stone through the skin. The stone absorbs the energy of the shock waves and this breaks it into smaller pieces. The stone fragments then pass with urine (Fig. 1). SWL is suitable for over 90% of all patients. However, its success depends on several factors like stone characteristics and your physical condition.
How is SWL performed ?
You are placed on an operating table with your flank positioned towards the shock-wave generator. The exact location of your stone is determined by ultrasound or x-ray.
During the procedure you will be able to hear the making of the shock waves; this sounds like little bangs. Your doctor will start at low intensity levels and slowly increase the power of the waves. There is no need for anaesthesia, but you will receive pain medication to comfort you during the procedure. SWL lasts about 45 minutes. If you have a large stone it is quite common that you need multiple sessions to completely break it.
When is SWL not recommended ?
There are several contraindications for SWL that either have to do with your physical condition or with the characteristics of the stone.
SWL is not recommended if:
- You are pregnant.
- You have high risk of severe bleeding.
- You have any uncontrolled infections.
- You have uncontrolled high blood pressure.
- Your physique makes it difficult to reach the stone.
- You have an aneurysm.
- You have an anatomical obstruction in the urinary tract, below the stone or in the bladder.
- Your stone is very hard (for instance cystine stones).
Will I be stone free directly after treatment ?
No. SWL breaks your stone into small pieces. These fragments will pass with urine in the days or weeks after SWL. You can get MET to help pass the stone fragments.
How do I prepare for the procedure ?
Your doctor will advise you in detail about how to prepare for the procedure. If you take any medication to prevent clotting of blood, discuss with your doctor if you need to stop taking it before the procedure. Do not eat anything 4 hours before the treatment.
How long will it take me to get back to my normal daily activities ?
In general you can go back to your regular activities right after treatment. However, make sure to get some rest on the day of the procedure. If you have received medication against the pain or to calm you down, do not drive a car or operate any other motorized vehicle within the first 24 hours after SWL.
If you don’t have any pain, it is important that you drink more than usual to flush out stone fragments. Try to drink more than 2 litres every day. If you have renal colic, ask your doctor how much you should drink. Do not drink any alcohol in the first 24 hours after the procedure.
You should filter your urine to catch stone fragments for stone analysis. Your doctor will give you a time schedule for regular control visits in the first weeks after SWL.
You need to go back to the hospital right away if you:
- Develop a fever
- Feel pain in your kidney or flank
- Still have blood in your urine more than 2 days after the treatment
Advantages of SWL
- Low risk of complications.
- No need for anaesthesia.
Disadvantages of SWL.
- Does not remove your stone. Instead, fragments of stone will pass in the following days or weeks, which may cause renal colic.
- You may need multiple sessions for larger stones.
KGP Hospital Hi- Kidney Stone Center
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