Extracorporeal Shock Wave Lithotripsy: An Effective Treatment for Kidney Stones

Extracorporeal Shock Wave Lithotripsy (ESWL) has been used in clinical settings since the early 1980s and has proven to be a safe and effective non-invasive treatment for most upper urinary tract stones. This method is widely accepted and continues to be a preferred option for many patients.

Stone size plays a key role in determining the success of ESWL. Renal stones smaller than 20mm in diameter are typically best treated with this method. Larger stones may require additional procedures or more than one session.

Stone location also affects treatment outcomes. Stones located in the renal pelvis are generally easier to break apart. Stones in the middle and upper kidney calyces tend to respond better than those in the lower calyx, which can be more challenging due to anatomical positioning.

Stone composition influences how easily they can be fragmented. Struvite and dihydrate calcium oxalate stones are relatively easy to break. Uric acid stones can be treated effectively with ESWL combined with stone-dissolving therapy. In contrast, monohydrate calcium oxalate and cystine stones are harder and may require more sessions or alternative treatments.

Anatomical abnormalities can impact the effectiveness of treatment. Patients with conditions such as horseshoe kidney, ectopic kidney, transplanted kidneys, or structural abnormalities in the urinary system may experience difficulty in passing stone fragments. In such cases, additional supportive measures may be necessary to aid stone removal.

The number of treatments and the interval between sessions are also important considerations. It is generally recommended that patients undergo no more than 3 to 5 ESWL sessions, depending on the type of lithotripter used. While there is no strict standard for treatment intervals, most experts suggest waiting 10 to 14 days between sessions to allow for kidney recovery and reduce the risk of injury.

There are several contraindications for ESWL. These include pregnancy, uncorrectable bleeding disorders, urinary tract obstruction below the stone, severe obesity or skeletal deformities, and high-risk medical conditions such as congestive heart failure, severe cardiac arrhythmias, and active tuberculosis in the urinary system.