Is Shock Wave Lithotripsy Necessary for Painless Kidney Stones?

Is it necessary to perform extracorporeal shock wave lithotripsy if kidney stones are not causing pain?

My brother visited the hospital on November 14, 2020, due to discomfort from right kidney stones.
The diagnosing physician determined that the left kidney stone was larger and recommended extracorporeal shock wave lithotripsy (ESWL).
During the procedure, my brother questioned the need for treatment on the left kidney, as he was not experiencing any discomfort there, and noted that he had undergone ESWL on the left kidney just two months prior, on September 12, 2020.
The physician performing the procedure immediately called the diagnosing physician to confirm that the lithotripsy would indeed be performed on the left kidney.
After the procedure, my brother returned home to rest but soon began to experience pain in the left flank.
As the pain intensified, he went to another hospital's emergency department around 6 PM, where the physician diagnosed him with a ruptured left kidney with bleeding and performed an emergency catheter-directed arterial embolization.
He was hospitalized for seven days for treatment and was eventually discharged.
Subsequently, I inquired with the original diagnosing physician why, when my brother was experiencing discomfort in the right kidney, the treatment was performed on the left kidney instead.
The physician responded that the decision was not related to pain; if the stone was large enough, it could be treated, as previous procedures had not caused any issues.

I would like to ask the physician:
1.
Given that the last lithotripsy on the left kidney was only two months ago, was there sufficient time for the kidney to recover?
2.
Is it appropriate medical practice to perform lithotripsy on the left kidney when the patient is experiencing discomfort in the right kidney, leaving the right kidney untreated?
3.
Are there established standards for the force applied during extracorporeal shock wave lithotripsy? Could improper machine operation have contributed to the kidney rupture?

Jiejie, 40~49 year old female. Ask Date: 2021/01/11

Dr. Li Xinyi reply Urology

1.
If a kidney stone grows too large before treatment, it can cause damage to the kidney.
Extracorporeal shock wave lithotripsy was performed two months ago, and in principle, it can be repeated after two months.
2.
We, as outsiders, cannot comment on whether there were any issues with the procedure, as we were not involved in the process and have no knowledge of it.
3.
It is possible that every physician may encounter cases where extracorporeal shock wave lithotripsy results in kidney injury; however, the exact reasons for this occurrence are not fully understood, and therefore, it cannot be completely avoided.

Reply Date: 2021/01/11

More Info

Shock Wave Lithotripsy (SWL) is a non-invasive procedure used to treat kidney stones by using shock waves to break the stones into smaller pieces that can be passed more easily through the urinary tract. Your brother's case raises several important questions regarding the necessity and safety of this procedure, especially when it comes to painless kidney stones and the timing of treatment.

1. Recovery Time Between Procedures: After a SWL procedure, the kidney and surrounding tissues require time to heal. While two months may seem sufficient for recovery, it can vary significantly based on individual circumstances, including the size and location of the stones, the patient's overall health, and any complications from previous procedures. In general, it is advisable to allow adequate time for recovery, especially if the kidney has undergone a procedure recently. If the kidney was still healing from the previous SWL, performing another procedure could increase the risk of complications.

2. Treatment of the Left Kidney When the Right Kidney Was Symptomatic: The decision to treat the left kidney instead of the symptomatic right kidney raises concerns about clinical judgment and adherence to medical protocols. Typically, the treatment should focus on the kidney causing symptoms unless there is a compelling reason to treat the asymptomatic kidney, such as the size of the stones or the risk of future complications. In this case, it appears that the decision was made based on the size of the stones rather than the presence of symptoms, which can be controversial. Medical professionals often consider both the size of the stones and the patient's symptoms when determining the appropriate course of action.

3. Standards for Shock Wave Lithotripsy: The force and frequency of the shock waves used in SWL are typically standardized based on the type and size of the stones being treated. However, the operator's experience and the specific equipment used can influence the effectiveness and safety of the procedure. If the machine is not calibrated correctly or if the operator does not follow established protocols, there is a risk of causing damage to the kidney, including the possibility of rupture. This highlights the importance of having experienced medical professionals perform the procedure and ensuring that proper protocols are followed.

In conclusion, while SWL can be an effective treatment for kidney stones, it is essential to consider the individual patient's circumstances, including the presence of symptoms, the timing of previous treatments, and the potential risks associated with the procedure. If there are concerns about the decision-making process or the outcomes of the treatment, it may be beneficial to seek a second opinion or consult with a specialist in urology. Additionally, ongoing communication with healthcare providers is crucial to ensure that all aspects of the patient's condition are being addressed appropriately.

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