Non-Invasive Kidney Stone Treatment at Springfield
Hospital
Q1 What is Lithotripsy?
Extracorporeal Shock Wave Lithotripsy (ESWL) is a treatment used
in the management of kidney or Ureteric stones.
Q2 How does Lithotripsy work?
The Lithotripsy machine generates a shock wave using sound
energy. This energy can be focused and magnified using “acoustic
lenses” which can be directed at your kidney stone, similar to how
a magnifying glass can focus the suns rays to a point. By focusing
the sound energy in this manner a shock wave can be produced at a
point on the stone with enough power to shatter and fragment the
stone. Usually a large number of small shock waves are generated so
that the stone can be fragmented without causing discomfort to the
patient.
Q3 How is the procedure carried out?
Your specialist will discuss with you the findings of kidney
stones and may suggest lithotripsy to try and clear you of the
stones. He will take a medical history from you about your general
health and any medications that you are taking. An appointment will
be made for you to attend the lithotripsy unit at Springfield
hospital. You will be informed by telephone or post. On attending
the Lithotripsy unit, you will be asked to change into a hospital
gown and will be given a mild painkiller. Please remind the staff
if you have any allergies (foods or drugs). You will be asked to
lie down on a large couch table and the radiographer (X-ray
technician) will use an ultrasound or X-ray scanner to locate your
stone on a TV monitor. The lithotripsy treatment will then start
and you will hear a number of loud regular clicks as the shock wave
energy is produced. The treatment starts at a low power initially
and it is gradually increased depending on how you feel.
Q4 How long does the treatment take?
A lithotripsy session normally takes about 1-1.5 hours. At the
end of the treatment you may go home after a nice cup of tea and we
usually advise that you have somebody with you as an escort. Some
patients stay in overnight, depending on their clinical
circumstances.
Q5 How many treatments will I need?
The number of treatments depends on the size and site of the
stone being treated. This will be discussed with you at
consultation and an X-ray will usually be taken prior to each
subsequent treatment to decide how the fragmentation of the
stone(s) is progressing.
Q6 Can everyone have lithotripsy?
Patients taking Warfarin should not have lithotripsy as they
have an increased risk of bleeding after such treatment. You must
advise the consultant if you are taking Warfarin. Some stones are
not amenable to treatment due to their position within the kidney
or urinary tract. This will be discussed with you by your
specialist prior to any treatment. If you have a cardiac pacemaker,
you will need evaluation by your cardiologist before lithotripsy
can be given. This is because the shock wave generator may
interfere with the function of your pacemaker. If you are morbidly
obese (over 120 kg), lithotripsy is not advised due to low success
rates and safety issues involving weight restrictions of the
lithotripter. Other patients not suitable for lithotripsy include
pregnant women, patients with severe bleeding disorders and
patients with a known abdominal aortic aneurysm.
Q7 Are there any complications from lithotripsy?
When a stone is fragmented by lithotripsy, the fragments usually
pass down the ureter into the bladder and then can be passed out in
the urine. If the fragments are too large, they can get stuck in
the ureter and cause the symptoms of renal colic. Occasionally,
patients have a J-J Stent inserted prior to lithotripsy to prevent
any blockages like this. Occasionally stones can harbour infection
and lithotripsy can release organisms into the urinary tract
causing urinary or blood infections. If there is any risk of this,
the patient is usually given high dose strong antibiotics prior to
the treatment and these are continued for a time afterwards. This
will be discussed with you at the time of treatment. If you feel
unwell or develop a fever after a treatment, you should contact the
urology department or your GP for urgent advice.
Q8 Can all stones be treated with lithotripsy?
If you develop a temperature or symptoms of cystitis, you may
have a urinary tract infection requiring a course of antibiotics.
If this occurs, you should contact either the urology department or
your GP for advice.
Q9 What follow up will I need?
Your progress will be monitored throughout the lithotripsy
treatment to see if fragmentation and stone clearance has occurred.
X-ray pictures and ultrasound scans will enable your specialist to
decide on your continuing management depending on if the
lithotripsy is working. If a stone fragment is passed, this can be
sent off for analysis and will give useful information on how to
advise you on dietary changes, etc. that may prevent you forming
further stones in the future.