What is the best way to explain lithotripsy (extracorporeal shock wave lithotripsy) to a patient?

How to Explain Lithotripsy to a Patient

Lithotripsy is a non-invasive procedure that uses shock waves generated outside the body to break kidney or ureteral stones into smaller fragments that can pass naturally through the urinary system.

What is Lithotripsy?

• Extracorporeal shock wave lithotripsy (ESWL) is based on the principle that high-pressure shock waves release energy when passing through areas of different acoustic impedance, breaking stones into smaller fragments 1
• The shock waves are generated outside the body and focused onto the stone using specialized equipment 1
• Hundreds or sometimes thousands of shock waves are delivered to adequately fragment the stones 1

The Procedure Process

• The procedure is typically performed on an outpatient basis and often doesn't require general anesthesia 2
• You will lie on a specialized table with the lithotripter positioned to target your stone 3
• The machine will deliver timed shock waves that pass through your body and concentrate on the stone 1
• Most modern lithotripters have variable power capabilities and can start with lower energy levels, gradually increasing as needed 1
• The procedure usually takes about 45-60 minutes to complete 2

Pain Management

• Most patients receive pain medication before the procedure, which may include non-opioid analgesics like diclofenac or mild sedation 4
• Pain levels vary between patients, but modern lithotripsy machines are designed to minimize discomfort 4
• Some patients may experience a sensation similar to a light tapping on the skin during the procedure 3

Success Rates and Outcomes

• For appropriate candidates, ESWL has good success rates, particularly for stones less than 2 cm in size 1
• Flexible ureteroscopy has shown higher stone-free rates than ESWL in some studies, particularly for pediatric patients with renal stones 1
• The stone fragments typically pass through your urine within a few days to weeks after the procedure 1

Potential Side Effects

• Common side effects include:
  • Blood in the urine (hematuria) - occurs in about 17% of patients 1
  • Mild pain or discomfort during fragment passage - occurs in about 12% of patients 1
  • Steinstrasse (a line of stone fragments in the ureter) - occurs in about 4% of patients 1
• Serious complications are rare but may include:
  • Symptomatic hematoma (0.21%) 1
  • Infection or sepsis (0.15%) 1

Special Considerations

• If you have a cardiac pacemaker or implantable cardioverter-defibrillator, special precautions will be taken 1
• The lithotripsy beam will be kept away from your cardiac device 1
• If you have atrial pacing and the lithotripsy system triggers on the R-wave, your doctor may need to disable atrial pacing before the procedure 1

After the Procedure

• You'll be encouraged to drink plenty of fluids to help pass the stone fragments 1
• You may be prescribed medications to help with stone passage (alpha-blockers) 1
• Most patients can resume normal activities within 1-2 days after the procedure 2
• Follow-up imaging will be scheduled to confirm successful stone clearance 3

Contraindications

• Lithotripsy is not recommended in certain situations:
  • Pregnancy 1
  • Uncontrolled urinary tract infections 1
  • Bleeding disorders 1
  • Severe obesity or skeletal malformations that prevent proper positioning 1
  • Arterial aneurysm near the stone 1