Background Information:

What are the other Names for the Procedure?

• ESWL (Extracorporeal Shock Wave Lithotripsy)
• Extracorporeal Shock Wave Lithotripsy (ESWL)
• Shock Wave Lithotripsy (SWL)

What is Lithotripsy surgical procedure?

Lithotripsy is a medical technique that involves breaking-up stones within the kidney, using shock waves and without any surgical intervention. It is also known as Shock Wave Treatment for Kidney Stones.

What part of the Body does the Procedure involve?

A Lithotripsy procedure involves the kidney, ureter, and bladder.

Why is the Lithotripsy surgical procedure Performed?

A Lithotripsy procedure may be performed for the following reasons:

• Presence of an abnormal-sized kidney stone that cannot be destroyed by regular methods
• To alleviate obstruction of urine flow
• To alleviate pain associated with kidney stone
• To reduce the possibility of an infection
• To reduce the possibility of injury to the kidney

What are some Alternative Choices for the Procedure?

In cases where Lithotripsy is contraindicated, other stone removal (surgical) procedures may be performed.

What are the Recent Advances in the Procedure?

The advances in lithotripsy machines have improved the precision targeting of the shockwaves. Due to this, the procedure can be performed faster and with fewer complications.

What is the Cost of performing the Lithotripsy surgical procedure?

The cost of Lithotripsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Lithotripsy procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.urologyhealth.org/urology/index.cfm?article=32 (accessed on 06/24/2014)

http://www.surgery.com/procedure/lithotripsy (accessed on 06/24/2014)

Prior to Lithotripsy surgical procedure:

How is the Lithotripsy surgical procedure Performed?

• A Lithotripsy is performed under sedation using a machine called a lithotripter
• The patient lies down and the stone is located using ultrasound or fluoroscopy (using x-rays to obtain real-time images of the insides of the body)
• The lithotripter produces shock waves that are transmitted through the skin and body
• The shock waves break the stone into smaller pieces. These tiny particles are then removed when the patient urinates
• Multiple sessions maybe required to completely remove some larger stones.

Where is the Procedure Performed?

A Lithotripsy procedure is usually performed in an out-patient specialized center for lithotripsy.

Who Performs the Procedure?

A urologist performs the Lithotripsy procedure.

How long will the Procedure take?

The Lithotripsy procedure usually takes about one hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Lithotripsy procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The following preparations are needed prior to a Lithotripsy procedure:

• A complete physical exam followed by blood tests to assess functioning of the kidneys, presence of any bleeding disorders and EKG to detect any abnormal heart rhythms will have to be performed
• Individuals with pacemakers need to inform their physician
• An IVP (intra venous pyelogram) is done by injecting a radio opaque dye into the vein. X ray pictures, taken after the introduction of the dye, will help in locating the stone
• It may be necessary to stop blood thinning medications prior to the procedure to reduce the risk of bleeding

A Lithotripsy is not advised under certain circumstances. You are advised to inform the physician, if these conditions are observed:

• Pregnancy
• Presence of abdominal aortic aneurysms
• Presence of bleeding disorders
• Lithotripsy is not advised for obese individuals

What is the Consent Process before the Procedure?

A physician will request your consent for Lithotripsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Lithotripsy surgical procedure?

Before a lithotripsy procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• X-rays of the Kidneys
• Electrocardiography (ECG)
• Ultrasound imaging
• Cystoscopy
• Computerized tomography (CT scan)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Lithotripsy (Shock Wave Treatment for Kidney Stones) procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Lithotripsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Usually no anesthesia is administered for the procedure. However, sedation is used in a high percentage of cases.

How much Blood will you lose, during the Procedure?

Patients undergoing Lithotripsy may pass some blood in the urine for a few days following the procedure.

What are the possible Risks and Complications during the Lithotripsy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

Lithotripsy is generally very safe. It may, however, be associated with:

• Abdominal pain/discomfort may occur
• Rarely, blood clots may form near the kidneys

What Post-Operative Care is needed at the Healthcare Facility after the Lithotripsy surgical procedure?

• At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise
• Individuals who undergo the procedure may have to be placed under observation for a certain duration of time. The duration of observance is determined by a healthcare provider on a case-by-case basis

After the Lithotripsy surgical procedure:

What are the possible Risks and Complications after Lithotripsy surgical procedure?

Post Lithotripsy procedure, the following complications may arise:

• There may be a risk of internal bleeding that may require a blood transfusion
• Infection of the kidney and bladder
• Pain in the abdominal region
• Small fragments of the broken stone can block urine outflow resulting in kidney damage
• Recurrence of the stone after a period of time
• The requirement of additional treatment if the stone is not completely eliminated from the body
• The above-mentioned complications are, however, very uncommon.

What is the Prognosis after the Surgery?

Lithotripsy is generally an effective procedure; although, certain stones may require more than one session.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, constipation, and abdominal swelling
• Experiencing difficultly or painful ability to urinate
• Loss of bladder/bowel function
• Noticeable discoloration of urine due to blood 
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Lithotripsy surgical procedure?

At home, the following post-operative care is recommended, after a Lithotripsy procedure:

• Plenty of fluid is advised, especially 2 weeks after the procedure. This increased fluid intake will help pass the small fragment of stones from the body
• Analgesics may be taken to relieve pain/discomfort (per physician’s advice)

How long does it normally take to fully recover, from the Procedure?

It takes approximately 2 -3 days to fully recover from the Lithotripsy procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Lithotripsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A out-patient specialized center for Lithotripsy
• An urologist

The patient is advised to inquire and confirm the type of billing, before the Lithotripsy (Shock Wave Treatment for Kidney Stones) procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA