Potential Risks of Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a widely used and effective treatment for kidney and urinary tract stones. It is known for being minimally invasive, safe, and generally well-tolerated by patients. However, if not performed correctly or without proper patient selection, it can lead to several complications.

One of the main concerns is the potential damage to the kidneys and ureters during the procedure. Repeated or high-energy shock waves may cause perirenal hematoma, renal bleeding, and even secondary hypertension. Additionally, as ESWL breaks larger stones into smaller fragments, there is a risk that these fragments may accumulate in the urinary tract, particularly in the ureter, forming what is known as a "stone street." This can lead to further complications such as ureteral obstruction, infection, or even narrowing of the ureter.

To minimize these risks, it is essential to conduct a thorough evaluation before the procedure. This includes blood tests, urinalysis, coagulation profile, and an electrocardiogram to ensure the patient is a suitable candidate. Any existing urinary tract infections should be treated prior to the procedure to reduce the risk of sepsis.

During the treatment, the appropriate shock wave voltage should be selected based on the size and location of the stone. After the procedure, it is important to allow sufficient recovery time before repeating the treatment. For kidney stones, a typical interval is about two weeks, while for ureteral stones, the interval may be shorter.

Moreover, the number of shock wave sessions should be carefully controlled to prevent excessive trauma to the kidneys. Following these guidelines can significantly reduce the likelihood of complications and ensure a safer outcome for patients undergoing ESWL.