Shockwave Therapy for Kidney Stones

Shockwave therapy for kidney stones involves the use of shock waves to break down stones in the kidney or urinary tract, facilitating their passage out of the body. This non-invasive treatment is preferred in many cases due to its effectiveness and relatively low risk compared to surgical alternatives.

One of the primary benefits of shockwave therapy for kidney stones is its non-invasive nature, which reduces the need for surgical procedures and their associated risks. Unlike surgical interventions, shockwave therapy typically does not require incisions, leading to quicker recovery times for patients. Additionally, shockwave therapy can effectively target and break down kidney stones without causing significant damage to surrounding tissues.

The purpose of shockwave therapy for kidney stones is to alleviate symptoms associated with kidney stones, such as severe pain, urinary tract obstruction, and potential kidney damage. By breaking down kidney stones into smaller fragments that can be easily passed through the urinary system, shockwave therapy helps relieve pain and discomfort while promoting the natural elimination of stones from the body.

According to a 2021 paper published in the International Journal of Urology by Dr. M. Chakit and colleagues, shockwave lithotripsy (SWL) is an extremely successful treatment for human kidney stones, positioning itself as the first-line choice in treatment modalities

How Kidney Stone Extracorporeal Shockwave Therapy Works?

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment option for kidney stones. It involves the use of high-energy shock waves to break up stones within the kidney and ureter, making it easier for the fragments to pass through the urinary tract. The procedure is performed using a lithotripter, which generates the shock waves that are targeted at the stone.

ESWT is a common treatment option for kidney stones, especially for smaller stones that can be easily seen with an X-ray, showcasing a noninvasive procedure that uses shock waves to break and remove stones. It is usually performed on an outpatient basis, meaning patients can go home the same day. A mild anesthetic is typically used to numb the kidney area before the procedure.

The effectiveness of ESWT varies depending on factors such as the size, number, location, and composition of the stones. It may not be recommended for patients with certain medical conditions, such as chronic kidney infection or scar tissue in the ureter.

In addition to kidney stones, ESWT has been used to treat other medical conditions, such as plantar fasciitis and chronic tendinopathy. The therapy works by increasing blood flow and promoting the formation of new blood vessels, which can help to heal injured tissues and reduce pain.

Who may need extracorporeal shock wave lithotripsy?

ESWL in particular can be a good choice for patients who are young, healthy, and have small stones. However, it may not be suitable for all patients, and care should be taken to ensure that the patient is adequately prepared for the procedure. The procedure can be uncomfortable, and there may be some discomfort and pain during the procedure. However, the pain is generally manageable with anesthesia or analgesics, and the procedure typically takes less than 30 minutes in total.

Possible indications for the use of ESWL include kidney stones, pancreatic stones, and stones in the ureter or kidney. The procedure involves the use of high-energy shock waves that cause the targeted structures to fracture. These fragments can then pass through the urinary tract and be eliminated over time, weeks after the procedure.

Risks and Complications of ESWL 

It’s important to note that ESWL is a procedure used to break up kidney stones, and while it is considered safe and effective, there are potential risks and complications that patients should be aware of before and after the procedure.

Some of the risks associated with ESWL include:

• Acute renal failure: This is a rare and potentially serious complication that can occur if the energy from the shock waves causes damage to the kidney tissues.
• Bleeding: Some patients may experience small amounts of bleeding from the kidney and bladder after ESWL. This can manifest as visible blood in the urine.
• Urinary tract obstruction: In some cases, ESWL may not completely break up all of the stone fragments, which can lead to blockages in the urinary tract.

Here are some of the complications associated with extracorporeal shock wave lithotripsy (ESWL) for renal lithiasis include:

• Hemorrhage
• Edema
• Acute tubular necrosis of the kidney
• Incomplete fragmentation, resulting in complications such as steinstrasse (pileup of fragments)
• Kidney stone displacement and fragmentation
• Direct impact of shock waves on tissues
• Infections, including sepsis, which can be asymptomatic or with urinary tract infection (UTI)
• Renal complications
• GI injury

It is important to note that ESWL is generally considered safe and effective for most individuals, but patients should work closely with their healthcare professionals to understand the potential risks and complications and follow proper medical protocols.

What is the success rate of shock wave lithotripsy? 

There have been various studies done on the efficacy of shock wave therapy, a noninvasive procedure that uses shock waves for kidney and other urological treatment-related stones!

Here are some of them:

According to Al-Marhoon, Mohammed S., et al’s 2013 study “Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital”, the Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones. The study found a success rate of 74% for renal stones and 88% for ureteric stones. The factors found to have a significant effect on complete stone clearance were serum creatinine and the number of shockwaves.

According to a 2004 study published in Scandinavian Journal of Urology and Nephrology by Mohamed Abdel-Khalek et al., titled “Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones–a multivariate analysis model”, patient age, stone size, location and number, radiological renal features and congenital renal anomalies are prognostic factors determining stone clearance after extracorporeal shockwave lithotripsy (ESWL) of renal calculi. The study developed a regression analysis model to estimate the probability of stone-free status after ESWL, which had a sensitivity of 83%, specificity of 91% and overall accuracy of 87%.

A 2022 research paper published in Cureus by a team of researchers led by Jasmin Alić from Bosnia & Herzegovina confirms the following:

Extracorporeal shock wave lithotripsy (ESWL) continues to be a safe and effective option for managing simple calculi in the distal ureter with a diameter of ≤10 mm. The study found an overall stone-free rate of 82.6% and efficiency quotient of 0.76 for ESWL treatment of distal ureteral stones ranging from 5-18 mm in size. The stone size and body mass index were identified as significant predictors of treatment outcome.

Overall the success rate of lithotripsy can be around 80% of the time for treatment for kidney stones and other renal stones.

Can lithotripsy be done without anesthesia? 

Yes, lithotripsy as a noninvasive procedure can be done without anesthesia. While some patients may prefer to receive anesthesia for the procedure, it is not a requirement depending on the complexity of the situation and the utility of general anesthetic

Is Shockwave lithotripsy painful?

Yes, shockwave lithotripsy may be painful. Pain management options, such as light sedation and local or general anesthetics, may be discussed with the patient and their doctor. The choice of anesthesia depends on the technique, the type of stone, and the patient’s condition.

What are the side effects of shock wave lithotripsy? 

Shock wave lithotripsy (SWL) is a generally safe procedure, but like any medical intervention, it can cause some side effects. The most common side effects are short-term and subside within a few weeks after the procedure.

• Pain and discomfort: You may experience flank pain, which is a dull ache in the lower back or side, for a day or two after the procedure, which is a common aftermath of the noninvasive procedure that uses shock waves to treat kidney stones. Passing the fragmented stones can also cause pain or discomfort as they move through your urinary tract. Pain medication can help manage this discomfort.
• Blood in the urine (hematuria) is often observed weeks after the procedure that uses shock waves to treat kidney stones. It’s common to see some blood in your urine for a few days to a few weeks after SWL. The urine may appear pink or reddish, but the amount of blood is usually small and should go away on its own.

Other potential side effects are less common and may require consultation with your doctor:

• Infection: There’s a slight risk of infection after SWL, which may cause fever or chills.
• Incomplete stone fragmentation: In some cases, the shock waves may not completely break up the stone, and additional procedures may be needed to remove the fragments, indicating the challenges in kidney stone treatment.
• Bruising: You might notice some mild bruising on your skin near the area where the shock waves entered your body.

It’s important to discuss any potential side effects with your doctor before undergoing SWL. They can explain the risks and benefits of the procedure in more detail and answer any questions you may have.

What are the disadvantages of shock wave lithotripsy?

The disadvantages of shock wave lithotripsy (SWL) include potential risks and adverse effects that patients should be aware of before undergoing the procedure. These risks may include bleeding, which can result in visible blood in the urine following the procedure, and the need for transfusion in some cases. Additionally, SWL can cause vascular trauma to the kidney and surrounding organs, leading to acute shock wave damage.

Lithotripsy may be associated with several potentially serious chronic adverse effects, although controversy exists regarding its role in causing or exacerbating conditions such as high blood pressure and diabetes. Furthermore, not all kidney stones may fragment successfully with SWL due to factors like size, location, and stone composition, potentially necessitating multiple treatments for adequate fragmentation.

Despite these disadvantages, SWL remains a widely used and effective treatment for kidney stones, particularly for uncomplicated upper tract stone cases. It offers the advantage of being non-invasive, with no incisions required, resulting in reduced hospital stays and recovery time compared to surgical procedures, making lithotripsy a preferred kidney stone treatment. However, some patients may still experience stone fragments too large to pass spontaneously, requiring further treatment with shock waves or alternative methods.

How long can you pass stones after lithotripsy?

After undergoing lithotripsy for kidney stones, the duration for passing stone fragments can vary. While some individuals may pass stone fragments within a week following the procedure, it can take up to 4-8 weeks for all the fragments to pass through the urinary tract. The passing of stone fragments may be accompanied by symptoms such as pain, nausea, red-tinged urine, and slight bruising or redness in the treatment area.

It is essential to drink plenty of water to facilitate the passage of stone fragments and follow any medication regimen prescribed by your healthcare provider. Additionally, resuming normal activities, including walking and mild exercise, after 24 hours can aid in the passage of stone fragments. If you experience severe pain, persistent red-tinged urine, or other concerning symptoms, it’s crucial to contact your healthcare provider for further evaluation and guidance.

What if ESWL doesn’t work?

If ESWL (Extracorporeal Shock Wave Lithotripsy) doesn’t effectively break up a kidney stone, additional procedures might be necessary. Depending on the situation, a second ESWL session or a ureteroscopy might be recommended to clear remaining stones. Urologists assess various factors like stone size, location, and patient health to determine the most suitable treatment approach post-ESWL failure, employing their knowledge on the different types of kidney stone treatment.

These factors, along with advancements in lithotripsy technology and surgical techniques, contribute to optimizing outcomes and patient care. Additionally, considerations such as stone density, skin-to-stone distance, and the presence of complicating factors like infection or renal impairment play crucial roles in determining the appropriate course of action after failed ESWL treatment.

How long does it take to recover from extracorporeal shock wave lithotripsy?

Recovery from extracorporeal shock wave lithotripsy (ESWL) is typically brief, with many patients able to resume daily activities within one to two days. Special diets are unnecessary, but staying hydrated aids in passing stone fragments, which may occur for several weeks after the procedure.

The procedure itself usually lasts about an hour, involving the use of high-energy shock waves to break kidney stones into smaller pieces that can be passed naturally through urine. Additionally, the success rate of ESWL varies, with around 70 to 90 percent of patients being stone-free within three months, particularly those with smaller stones.

However, it’s essential to note that not all kidney stones can be treated with ESWL, and some patients may require additional procedures or interventions, as per guidelines from the national kidney foundation. Factors such as age, overall health, stone size, and composition influence the recovery process, which can range from days to weeks. It’s crucial for patients to follow post-procedural instructions provided by their healthcare providers and to seek medical advice if experiencing severe pain or complications during recovery.