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LITHOTRIPSY (EXTRA CORPOREAL SHOCK WAVE

LITHOTRIPSY or ESWL)
AN INFORMATION LEAFLET
Written by: Department of Urology
May 2011
Stockport: 0161 419 5698
Websi t e: ww w. s t o c k p o r t . n h s . u k
Tameside: 0161 922 6696/6698
Webs i t e: w ww. t a m e s i d e . n h s . u k
Macclesfield: 01625 661517



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What Is Lithotripsy (Extra Shock Wave Lithotripsy)?
Extracorporeal Shock Wave Lithotripsy (ESWL) is used to treat kidney stones by breaking them up
into fragments, which are small enough so that they may be passed naturally.
Ultrasound and x-ray screening equipment are used to provide a precise image of the kidney
stone, and then pulses of energy are then aimed at the stone causing mini shock waves, which will
break it down into small fragments.
ESWL is an outpatient procedure which does not require any type of anaesthetic (numbing or
being put to sleep). It is carried out at Stepping Hill Hospital, Stockport.


What Are The Benefits?
Kidney stones can cause symptoms such as pain, infection and/or obstruction of the drainage of
urine from the kidney to the bladder. This treatment is used to remove the stone and therefore
relieve these symptoms.


Are There Any Risks Involved?

Blood in the urine - this is quite normal and decreased by drinking plenty of fluids.
A bruise on your back - this is caused by the head of the equipment being placed on the skin.
Pain in kidney - the passage of small stone fragments through the urinary system may cause
pain. If you experience any discomfort you should take the same painkillers as you would for
a headache.
Infection - occasionally infection occurs and may require antibiotic treatment. You should see
your GP as soon as possible if you experience a fever or feel generally unwell.
Difficulty or inability to pass urine you should see your GP as soon as possible if this occurs.
Obstruction caused by stone fragments rarely stone fragments can get stuck in the ureter (tube
between the kidney and bladder) which occasionally requires further surgery.
Repeat treatment the shockwaves will weaken the stone initially and may not break it
completely. You may therefore need more than one session of lithotripsy to get rid of the
stone completely.
Further surgery occasionally more invasive procedures or operations are required if
lithotripsy has not been successful in completely removing the stone.
What Are The Alternatives?
Open surgery (cut on your abdomen or on the side of the affected kidney).
Percutaneous nephrolithotomy (a small incision on the side of the abdomen of the affected kidney),
which enables a special needle to travel through the skin to break up the stone.
Do nothing, although this may affect your health.

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How Long Does The Treatment Last For?
The treatment will usually last for about twenty minutes. Very occasionally a mild sedative may be
offered if you are particularly worried or anxious, as it is very important that you stay extremely still
throughout the treatment.


On The Day of the Procedure

If your treatment is in the morning, you should have a light breakfast (such as toast or cereal). If
your treatment is in the afternoon, you should have light lunch (such as soup or a sandwich).
You should drink your normal amount of clear fluids.


What Happens To Me When I Arrive At The Department?
You will be greeted by the nursing staff looking after you, who will prepare you for the procedure.
The treatment will be explained to you fully and you will be asked to sign a consent form.
Any medication required prior to the procedure will then be given to you.

As x-ray equipment is used throughout the treatment, it is important to let the staff know if you
think you may be pregnant.

You should also let the nursing staff know if you are taking medications to thin your blood
(anticoagulants such as warfarin, Clopidogrel or a large dosage of aspirin).

If you have a pacemaker, have problems with high blood pressure or are not feeling well on the day
of your treatment, please tell the nursing staff.
During your time at the clinic, please feel free to ask the nursing staff any questions you may have
about the treatment or inform them of any worries or anxieties you may have. It is important that
during the treatment, you are as relaxed as possible.


What Happens During The Treatment?

When you have been fully prepared, you will be escorted into the room where the lithotripsy
equipment has been set up and the technicians will ask you to lie on the treatment table, usually
face down. As the kidneys are situated towards the back of the body, this helps to treat the stone
more effectively. If your stone is in one of your ureters, you may be asked to lie on your back.
Once you are in position on the treatment table, you will be asked not to move and to keep your
breathing as shallow as possible. This helps to locate the stone using the x-ray or ultrasound
equipment. The lithotripter machine is then linked to the x-ray equipment and ultrasound jelly is
applied to the area where the lithotripter treatment head (a cushion with water inside) will go. The
jelly helps to create a good seal between your skin and the cushion, and as it is water based, it is
easily washed off after the procedure.
When the stone is in the correct target area, treatment can begin. Throughout the treatment you
will hear a clicking noise and may feeling something like a flicking on the area being treated. Some
people have described this as a small electric shock and it may feel uncomfortable but should be
bearable. If it gets too painful, let the nursing staff or technicians know, as throughout the
treatment the power/intensity of the machine may be slowly increased, to ensure a good enough
level of power to break or weaken the stones.

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The stone will be monitored via the x-ray equipment throughout the procedure, to make sure that it
has not moved. It may be necessary to move the table at times, to ensure accurate treatment of
the stone. The breaking down process may take slightly longer with hard stones and the treatment
may last up to forty five minutes.


What Happens After The Procedure?

You will go back to the clinic nursing staff who will ensure you pass urine before you leave the
department.

Discharge Arrangements
You will usually only need to stay about an hour following the treatment, to ensure that you are
comfortable and not experiencing any problems.
It is necessary to arrange for a responsible adult to collect you from hospital and transport you
home following the treatment, as medication may be given which can make you feel a little sleepy.
It is extremely important that you drink two to three litres of fluid for up to seven days after the
treatment. This will help flush out the kidneys and aid the breaking down of the stone process. If
you do not drink, the treatment will not work.
You will be given an appointment to attend the stone clinic at your local urology department, two
weeks after the treatment. An x-ray will be taken on arrival at this next appointment, before you
see the doctor.


Day To Day Living

You can resume your normal activities the day after your treatment.
Stay as active as you can after the treatment. Swimming and walking are recommended, as they
may help you to pass the small stone fragments.
The passage of stone fragments may cause pain and/or a temperature. You should take simple
painkillers (for example paracetamol) if you experience any discomfort.
If There Is A Problem?
If you have any problems or concerns following your treatment, please contact your GP
immediately.
Other Useful Contacts or Information
If you have any questions you want to ask, you can use this space below to make notes to remind
you.

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Source
In compiling this information leaflet, a number of recognised professional bodies have been used,
including the British Association of Urological Surgeons. Accredited good practice guidelines have
been used.
If you have a visual impairment this leaflet can be made available in bigger print
or on audiotape. If you require either of these options please contact the Health
Information Centre on 0161 922 5332


If you would like any further information please telephone the Urology Nurse Specialists at your
local Urology Department on:

Stepping Hill 0161 419 5695
Tameside 0161 922 6696/6698
Macclesfield 01625 661517





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Urology Department
Elective Services
June 2003
Version 1.2