Extracorporeal Shock Wave Lithotripsy (ESWL) in Delhi

Indications

ESWL is typically indicated for:

• Kidney stones and ureteral stones that are less than 2 cm in diameter.
• Stones that are visible on X-rays.
• Stones that are not too dense to be broken up by shock waves.
• Patients without anatomical abnormalities that would hinder the passage of stone fragments.

Preoperative Preparation

• Evaluation: Imaging studies such as X-rays, CT scans, or ultrasounds to assess the size, location, and composition of the stones.
• Lab Tests: Blood and urine tests to check for infection and kidney function.
• Antibiotics: Prophylactic antibiotics if there is an infection.
• Dietary Restrictions: Patients may be asked to fast for a certain period before the procedure.

Procedure Steps

1. Anesthesia: ESWL can be performed under general anesthesia, regional anesthesia, or sedation with local anesthesia, depending on the patient’s condition and preference.
2. Positioning: The patient is positioned on a specialized table or water cushion, with the stone localized using fluoroscopy (X-ray) or ultrasound guidance.
3. Shock Wave Generation:
   • A machine called a lithotripter generates shock waves.
   • These shock waves are focused on the stone using a water cushion or gel to conduct the waves through the body.
4. Stone Fragmentation:
   • Shock waves pass through the skin and body tissues to reach the stone.
   • The stone is broken into smaller pieces over the course of 30 minutes to an hour, depending on the size and hardness of the stone.
5. Completion: After the procedure, the fragments of the stone are small enough to pass through the urinary tract.

Postoperative Care

• Recovery: Most patients can go home the same day.
• Pain Management: Pain relief is provided as needed, especially for the passage of stone fragments.
• Hydration: Patients are encouraged to drink plenty of fluids to help flush out stone fragments.
• Straining Urine: Patients may be advised to strain their urine to collect and analyze stone fragments.

Complications

While ESWL is generally safe, potential complications include:

• Pain as stone fragments pass through the urinary tract.
• Blood in the urine (hematuria).
• Infection.
• Bruising or skin irritation at the site of shock wave entry.
• Incomplete fragmentation, requiring additional procedures.

Follow-Up

Regular follow-up visits are essential to:

• Monitor the passage of stone fragments.
• Ensure complete stone clearance with follow-up imaging (X-rays, ultrasounds).
• Manage any complications.
• Prevent recurrence of stones through dietary and lifestyle modifications.

Advantages of ESWL

• Non-invasive with no surgical incisions.
• Short recovery time.
• Can be performed on an outpatient basis.
• Effective for most stones located in the kidney and upper ureter.

Conclusion

ESWL is a highly effective and non-invasive treatment for kidney stones and ureteral stones that are less than 2 cm in diameter. With proper preoperative assessment, skilled application of the procedure, and appropriate postoperative care, patients can achieve excellent outcomes and relief from symptoms associated with kidney stones.