ESWL Treatment for Kidney Stones

Kidney Stone Positioned on X-ray
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About 12% of people will have kidney stones at some point in their lives. In fact, kidney stones are the third most common urological presentation behind urinary tract infections and prostate disease.

Kidney stones are exquisitely painful and result in back, flank or groin pain. The character of this pain is typically intermittent. Other symptoms that accompany kidney stones are fever, chills, nausea, vomiting, blood in urine. In most people, the pain of a kidney stone compels a trip to the emergency room.

Formation

Stones can form in the kidney, and then make their way down the ureter. (Stones may also form in the bladder, but this is more likely to be related to an enlarged prostate and incomplete emptying.) When stones are found in the kidney, they can also be referred to as renal calculi or nephrolithiasis.

Composition

Kidney stones are usually composed of calcium oxalate. However, depending on their cause, the composition of kidney stones varies, and they can also be made of calcium phosphate, struvite, cystine or uric acid. When kidney stones pass into the urine, they can be detected as sediment which can aid in the diagnosis of this condition.

Obstructive Versus Nonobstructive

Kidney stones can either be obstructing or nonobstructing. The larger the stone, the more likely it will obstruct the urinary tract. Obstructive kidney stones tend to be larger (ranging from 5 to 10mm and above) and are more likely to require aggressive treatment to break it up, but a stone of any size can block the ureter.

Stones that are around 1 mm have a 90% chance of passing without intervention, whereas stones around 5 mm have a 50% chance of passing without intervention. A stone above 10 mm has a less than 10% chance of passing without intervention.

Nonobstructive kidney stones are smaller and usually pass on their own and don't require any form of medical intervention.

If you present to the emergency room with stones that are likely to pass, you'll receive pain medications and possibly medications to help you pass your stone through the ureter, along with medication to help with nausea and antibiotics.

Diagnosis

When a person presents to the emergency room with a suspected diagnosis of kidney stones, an abdominal computed tomography (CT) scan without contrast is usually ordered to visualize any kidney stones. Kidney stones can also be visualized using other diagnostic modalities such as ultrasound or X-ray. Additionally, a urinalysis is also ordered to examine the urine for crystals and red blood cells (which indicate bleeding).

Extracorporeal Shock Wave Lithotripsy (ESWL) Treatment

Large kidney stones are often removed with minimally invasive procedures by a urologist. These include placement of a stent (open tube) to help drain the kidney, use of a laser to fragment the stone, and extracorporeal shock wave lithotripsy (ESWL).

With ESWL, high-energy sound waves are used to shatter kidney stones visualized using ultrasound. These bits of stone can then freely pass through the urinary tract via the urine. Interestingly, the technology used to develop ESWL is based on technology used to develop supersonic aircraft.

High-energy sound waves can be directed through a water cushion placed up against your skin. The procedure can be uncomfortable and anesthesia is commonly administered during the procedure. Anesthesia also hastens recovery times after ESWL.

Although ESWL is generally safe, rarely it can cause pain, heart arrhythmias, or issues with blood pressure. Some degree of renal bruising and bleeding in the urine is normal after use of ESWL.

ESWL is a good treatment option for stones in the kidney or in the proximal ureter. The doctor may place a stent to help you pass your stones after an ESWL.

In addition to surgery or ESWL, a procedure called percutaneous nephrolithotomy is sometimes used for larger stones, in which a small opening is made into your kidney to remove the stones, usually greater than 2 cm.

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Treating Kidney Stones

Prevention

Kidney stones are due to the combined effects of genetics and environment. Depending on the cause, you can sometimes take certain steps to prevent kidney stones. The most common risk factor associated with kidney stones is dehydration; thus, drinking plenty of water or even taking diuretics (water pills) can help prevent kidney stones. (Your physician should prescribe the diuretics.) 

Furthermore, certain foods can contribute to the development of certain types of kidney stones. For instance, spinach contains oxalate, a component of kidney stones composed of calcium oxalate. According to the National Institutes of Health, reducing the amount of meat and sodium you eat can also prevent calcium oxalate kidney stones.

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Article Sources
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  1. National Institutes of Health. Eating, Diet & Nutrition for Kidney Stones. Updated May 2017.

Additional Reading
  • Cereda M, Kennedy S. Cereda M, Kennedy S Cereda, Maurizio, and Sean Kennedy.Chapter 61. Anesthetic Considerations for Genitourinary and Renal Surgery. In: Longnecker DE, Brown DL, Newman MF, Zapol WM. Longnecker D.E., Brown D.L., Newman M.F., Zapol W.M. Eds. David E. Longnecker, et al., eds. Anesthesiology, 2e. New York, NY: McGraw-Hill; 2012.

  • Hwang JQ, Poffenberger C. Hwang J.Q., Poffenberger C Hwang, James Q., and Cori McClure Poffenberger.Chapter 10. Renal and Urinary System Ultrasound. In: Carmody KA, Moore CL, Feller-Kopman D. Carmody K.A., Moore C.L., Feller-Kopman D Eds. Kristin A. Carmody, et al., eds. Handbook of Critical Care and Emergency Ultrasound. New York, NY: McGraw-Hill; 2011.