Stone Crushing with External Sound Waves (ESWL)

ESWL

It is the process of breaking stones with short-signaled high-energy sound waves produced from an external device called a generator. The device consists of 3 main parts. A table on which the patient lies, a generator, and a water bladder where sound waves enter the body through the skin, and an X-ray or ultrasound device used to focus the stone. With the ESWL method, sound waves entering the body from the skin break the stone into small pieces and these very small stone pieces leave the body through the urinary tract.

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During the procedure, the sound waves produced from the generator are transmitted from the patient's skin to the focused stone. Sound waves are produced at a certain frequency per minute, and the frequency can be increased during the process. The process takes about 20-45 and may need additional sessions. There is no need to stay in the hospital after the procedure.

Who is ESWL Applied to?

The biggest advantage of the procedure is that it does not require anesthesia like other treatment methods. Therefore, it can also be applied to patients who are inconvenient to receive anesthesia. However, since the procedure is mildly painful, painkillers are administered beforehand.

It is applied especially for stones smaller than 2 cm in the kidney and for stones smaller than 1 cm in the urinary canal (ureter).

Can ESWL Procedure Be Applied to Children?

External lithotripsy (ESWL) with sound waves can also be successfully applied in kidney and ureteral stones in children. After the procedure, children can throw stone fragments more easily than adults. The only concern for children is the need for anesthesia during the procedure. A light anesthesia is applied to pediatric patients so that the children do not feel pain during the procedure and the children do not prevent them from moving and focusing on the stone. As in adults, ESWL is an appropriate treatment method in the treatment of kidney stones smaller than 2 cm and urinary tract (ureter) stones smaller than 1 cm.

To Whom ESWT Process Is Not Applied?

It is inconvenient to do it in those who have active urinary tract infection, pregnant women, those with uncontrolled high blood pressure, those who use blood thinners, those who have bleeding disorders, those who have a structural obstruction in the urinary tract that will prevent the shedding of broken stone pieces, and those who have a balloon-like swelling (aneurysm) in the large vein (aorta) that comes out of the heart. .

It is not recommended in some special cases because the hardness of the stone and the location of the kidney affect its success.

The procedure is usually unsuccessful in stones with a high density (>1000HU) in the transplanted tomography. Again, ESWL is not recommended if there is an anatomical condition in the lower chamber of the kidney (calyx) that will prevent the stones from being expelled from this chamber.

How to Prepare Before ESWL?

The procedure does not require any special preparation as anesthesia is not given to patients other than children. Continuous use of diabetes or blood pressure medications should be continued. Blood thinners should be discontinued a few days before the procedure. The procedure can be performed by meeting with your cardiology or internal medicine doctor and getting their approval.

How Long After To Return To Daily Activities Or Work?

One of the advantages of the ESWL procedure is that it does not require hospitalization and returns to normal life in a short time. It is recommended that patients rest at home after the procedure. Since the broken stones will be excreted from the urinary tract, it is recommended to use painkillers and drugs that expand the urinary canal after the procedure. Patients can return to their normal activities the day after the procedure. During this period, it is recommended to take plenty of fluids.

What Are the Risks of the ESWL Process?

The stones that are broken down by the process leave the body through the urinary tract. Especially the stone pieces in the lower chamber (calyx) of the kidney cannot be thrown out and remain there. These small fragments predispose to stone formation and small fragments may enlarge (21-59%). While the stones are poured, pain (renal colic) and urinary tract (ureter) line up along the length of the patient and obstruct the urinary tract. This condition is called a stone tract and is usually treated according to the severity of the blockage.

Shock sound waves transmitted from the skin to the stone during the stone breaking process can also damage the kidney and surrounding tissues. It may have side effects ranging from mild to severe bleeding in the kidney (<1-19%). Rarely, it can cause damage to the surrounding tissues. It may cause heart rhythm problems in heart patients (11-59%). It can be applied by taking the necessary precautions, especially in patients with a pacemaker.

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