Extracorporeal Shock Wave Lithotripsy: Risks and Success Rates

Extracorporeal Shock Wave Lithotripsy (ESWL)

Hello, Dr.
Hsu! I would like to ask you if extracorporeal shock wave lithotripsy (ESWL) has any adverse effects on the human body.
What is the likelihood of passing a stone (over 1 cm) after the procedure? How many sessions are typically needed to completely eliminate the stone? Thank you.

Yin Yin, 50~59 year old female. Ask Date: 2013/04/25

Dr. Xu Weikai reply Urology

Hello, every surgery has potential side effects, and extracorporeal shock wave lithotripsy (ESWL) is no exception.
Possible complications include hematuria, pain, and renal bleeding.
The likelihood of these occurrences is related to the type of equipment used and the experience of the physician.
For a 1 cm stone, if it is fragmented and combined with medication and dietary adjustments, most of the fragments can typically be expelled within two weeks.
However, some stones may be difficult to pass due to their location and may require positional drainage.

I cannot provide a specific probability for stone expulsion, as it depends on individual factors such as body constitution, stone hardness, location, and dietary habits.
As for how many procedures are needed to completely expel the stones, this question is essentially non-existent.
The physician's role is to use the machine to break the stones; the rest is up to the patient.
In other words, the fragmented stones are not guaranteed to be expelled after a certain number of procedures; it depends on when the patient is able to pass the stones, which is unrelated to the physician or the equipment used.
If there are any unclear points, feel free to ask again for further discussion.
Online responses should only serve as a reference; it is essential to seek medical care at a healthcare facility when necessary.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2013/04/25

More Info

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive procedure used to treat kidney stones and other types of calculi by using shock waves to break them into smaller pieces that can be more easily passed through the urinary tract. While this procedure is generally considered safe and effective, it is important to understand the potential risks and success rates associated with it.

Risks of ESWL
1. Kidney Damage: Although rare, there is a possibility of damage to the kidney tissue due to the shock waves. This can lead to complications such as hematoma (a localized collection of blood outside of blood vessels) or even renal parenchyma injury.

2. Infection: There is a risk of urinary tract infections (UTIs) following the procedure. The fragmentation of stones can create a pathway for bacteria to enter the urinary tract.

3. Bleeding: Some patients may experience hematuria (blood in the urine) after the procedure. This is usually temporary and resolves on its own.

4. Stone Fragment Retention: In some cases, not all stone fragments may be successfully passed after the procedure. This can lead to the need for additional treatments or procedures.

5. Pain and Discomfort: Patients may experience pain or discomfort during and after the procedure as the stones are broken down and passed.

6. Other Complications: Rarely, complications such as ureteral obstruction (blockage of the ureter) or the formation of new stones can occur.

Success Rates
The success rate of ESWL can vary based on several factors, including the size and location of the stone, the patient's anatomy, and the type of stone. Generally, the success rate for stones smaller than 2 cm is about 70-90%. For larger stones, the success rate may decrease, and additional treatments may be necessary.

Number of Sessions Required
The number of ESWL sessions required to completely eliminate a stone can vary. Many patients may require only one session, especially if the stone is small. However, larger stones or those that are more difficult to fragment may require multiple sessions. On average, patients may need anywhere from one to three sessions, but this can differ based on individual circumstances.

Conclusion
In summary, while ESWL is a widely used and effective treatment for kidney stones, it is not without risks. Patients should be informed about the potential complications and the likelihood of needing multiple treatments. It is essential to have a thorough discussion with a urologist or healthcare provider to understand the specific risks and benefits in your case, as well as to establish a follow-up plan to monitor the success of the treatment and manage any potential complications. If you have any concerns or experience unusual symptoms post-procedure, it is crucial to seek medical advice promptly.

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