Frequently Asked Questions - ESWL treatment options

These faq's could be suitable to ESWL service providers also.
Is ESWL treatment option good for kidney stones?

 

Your choice could be between letting the stone pass off in urine from your body on its own while using pain medications, or breaking up the stone to reduce the size to speed it along and lessen the pain. Try considering the following when making your choice.
If your stone is not made of cystine or uric acid, you have not had a stone earlier, and you are otherwise healthy and the size of your stone is small then there is a possibility of it passing on its own. It may also help determine the type of treatment most suitable for you.
 
The smaller the stone is, the more likely it is to pass off in urine on its own. About 9 out of every 10 stones smaller than 5 mm and about 5 out of every 10 stones 5 mm to 8 mm pass on their own.If in your case the stone is small it will probably pass off. You can control the associating pain with medication at home and normal pain medication may be enough. If the stone is not likely to pass as it is bigger than talk to your doctor about all your treatment options available to you.
If you cannot control your pain with normal pain medication, or if the stone is blocking the urine out flow, your best choice may be an ESWL treatment . ESWL may work best for kidney stones that are still located in the kidney. It may be a bit harder to break up a stone that has moved into the ureter, although this is still possible. You have options other than ESWL, but it is the most commonly used method because it is effective and does not require any surgery.
ESWL is not the only method used to break up kidney stones, but it is the most commonly used and preferred method because it does not require surgery or any intervention.

 

How could pain be controlled in renal stone patients ?

 

Pain relief is the most important factor in stone treatment management and there has been a trend toward the use of non-steroidal anti-inflammatory agents (NSAID) as first line agents. This could be because of the concern towards opiate seeking patient.
Evidence suggests opiates and NSAID’s are equally effective at controlling pain (ureteric colic) and are often used in combination. There is concern that opiates may lead to an increase in ureteric tone but conversely NSAID may interfere with the kidney’s ability to auto regulate its response to obstruction leading to a reduction in renal blood flow.
NSAIDs are contraindicated in patients with pre-existing renal impairment and care should be taken in those with asthma and pre-existing gastro-intestinal disorders. The role of other agents such as desmopressin and acupuncture is uncertain.
Does all patient require Hospitalization ?

 

Kidney stones are very painful, and people often seek immediate treatment. But not all patients require hospitalization for renal colic, however it is mandatory in some circumstances namely; signs or symptoms of superadded infection requiring emergency treatment to relieve obstruction; unremitting, uncontrolled pain, renal failure relating to an obstructing stone in a single functioning kidney or bilateral calculi and probably in those patients with stones of sufficient size that they are unlikely to pass (i.e. ›5mm).
Which patients would require priority ?

 

Most calculi will pass spontaneously (90%) and the golden rule is that stones ‹5mm will pass naturally. There is now quite strong evidence that previously normal kidneys can resist clinically significant damage from obstruction for up to 4 weeks and therefore it is reasonable to leave stones of ‹5mm for four weeks prior to considering intervention. The indications for treatment of ureteric stones are therefore

1) Uncontrollable pain

2) Renal impairment with single functioning renal units or bilateral stones

3) Stones larger than 5mm diameter

4) Stones that have been in-situ for up to 4 weeks

5) Recurrent urinary tract infections

 

This list is neither exhaustive nor absolute and often clinical situations will dictate different strategies tailored to individual patients.
What could be ESWL complications ?

 

There are a number of well-recognised complications associated post ESWL and these include ureteric colic, steinstrasse (impacted fragments in the ureter) infection and perinephric haematoma. The question of whether ESWL leads to significant renal damage and hypertension remains unanswered till today. So after 30 years of ESWL existence this could well be stated as a Myth.
There are a few contraindications to ESWL and these include anticoagulation, pregnancy and an abdominal aortic aneurysm It is like you usually do not have ESWL if you are pregnant or have a bleeding disorder kidney infection, urinary tract infection, kidney cancer, or kidneys with abnormal, structure or function.
What are the side effects of ESWL?

 

ESWL has a few side effects, which may include the following:

 

The most common side effect is pain caused by passing of fragments through the urinary tract.

Sometimes if stone is not fragmented using correct parameters of shockwave pressure etc. Large fragments can be formed and block the urinary tract. Thereafter blocking the urine flow. Such blocked fragments need to be removed with a ureteroscope.

Infection in the Urinary tract.

Bleeding around the outside of the kidney.

 

 

What to do if I kidney stone(s) block the ureter ?

 

If you have any indication like a stone or multiple pieces blocked in the urinary path and further blocking the urine flow or/and causing pain, you can choose from the following options:

 

Wait for the stone to pass while using medicine to control the pain. Your doctor may also prescribe a medicine to help the stone pass, such as a calcium channel blocker.

Use ESWL to break up the stone in the hope that the pieces of stone pass more quickly with less pain.

Use another option, such as percutaneous nephrolithotomy or nephrolithotripsy, ureteroscopy, or open surgery.

The decision about which option to use greatly depends upon your personal feelings and your medical status.

In which conditions ESWL can be used ?

 

ESWL can be considered if:

 

The stone is not passing on its own and is causing pain that will not go away.

The stone is completely blocking the urine flow.

You have only one working kidney, and your doctor worries that the stone is affecting that kidney's ability to function.

The stone is causing serious bleeding.

The stone continues to grow.

You have had a kidney transplant, and your doctor worries about damage from a stone.

In which conditions ESWL cannot be used?

 

ESWL cannot be used if:

 

You are pregnant.

You have a bleeding disorder.

You have a kidney infection, urinary tract infection, or kidney cancer.

You have kidneys with abnormal structure or function.

You may need more than one treatment to break up a stone. The larger the stone, the more likely it is that you will need multiple treatments.

You have a cystine kidney stone, which does not break up easily.

You take blood thinners (anticoagulants), and your medication cannot be stopped to perform the procedure.

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