Extracorporeal Shock Wave Lithotripsy Treatment in Delhi, India

Shock wave lithotripsy (SWL) is a commonly used non-invasive procedure for treating kidney stones. It employs high-energy shock waves to break down kidney stones into smaller sections, allowing them to pass through the urinary tract more easily. SWL has revolutionised the management of kidney stones, offering several advantages over traditional surgical techniques. This article explores the indications, advantages, disadvantages, preparation, procedure, risks, post-operative measures, and success rate associated with shock wave lithotripsy.

Indications

Shock wave lithotripsy is primarily indicated for the treatment of kidney stones that are less than 2 centimetres in size. It is particularly effective for stones located in the kidney or upper ureter. SWL is suitable for patients with normal kidney function and those who are not pregnant. However, certain stone characteristics, such as stones composed of cystine or certain types of calcium, may affect the success rate of the procedure.

Who Should Not Go For Lithotripsy?

• Pregnant women
• Patients with bleeding disorders, kidney disorders
• Obese patients

Advantages of Shock Wave Lithotripsy

• Non-Invasive: SWL is a non-surgical procedure, which means it does not require incisions or invasive techniques. This reduces the risk of complications, minimises pain, and shortens recovery time compared to traditional surgical interventions
• Outpatient Procedure: Shock wave lithotripsy is typically performed on an outpatient basis, thereby avoiding hospitalisation
• High Success Rate: SWL has a success rate of approximately 70-90% in breaking down kidney stones, depending on various factors such as stone size, location, composition, and patient characteristics
• Minimal Recovery Time: After undergoing SWL, patients can usually resume their normal activities within a couple of days, compared to several weeks of recovery required for surgical procedures
• Repeatable: In case of incomplete stone fragmentation or the presence of residual stones, SWL can be repeated without significant risks or complications

Disadvantages of Shock Wave Lithotripsy

• Size and Location Limitations: Shock wave lithotripsy may be less effective for larger stones (greater than 2 centimetres) or stones located in the lower ureter, as the shock waves may not adequately reach or fragment the stones
• Multiple Sessions: Depending on the size and composition of the stones, multiple sessions of SWL may be required to achieve complete stone clearance, potentially prolonging the treatment duration.
• Stone Residuals: In some cases, small stone fragments may remain after SWL, necessitating additional treatments or alternative interventions to clear them
• Discomfort and Bruising: During the procedure, patients may experience discomfort and bruising on the treatment site due to the shock waves. This discomfort is typically temporary and manageable with pain medications
• Potential for Complications: Although rare, complications such as bleeding around the kidney, infection, or injury to surrounding organs may occur. However, these risks are significantly lower compared to surgical interventions

Preparation for Shock Wave Lithotripsy

Anaesthesia is used by the doctor to help the patient remain calm and still during the procedure. It could be either general, regional, or local anaesthesia; hence, the patient is advised not to have any fluids 6 hours prior to the procedure. Patients can continue their regular medications, but blood-thinning medications are stopped by the doctor for around five days before the shock wave lithotripsy procedure. A mid-stream urine culture test is advised by the doctor to confirm the sterility of urine before the treatment.

Before undergoing SWL, patients typically need to follow these preparations:

• Medical Evaluation: A comprehensive medical evaluation is conducted to assess the patient's overall health, kidney function, stone characteristics, and suitability for SWL
• Fasting: Patients are often required to fast for a few hours before the procedure, depending on the specific instructions provided by the healthcare provider
• Medication Adjustment: Certain medications, such as blood thinners, may need to be adjusted or temporarily discontinued to reduce the risk of bleeding during the procedure
• Hydration: Adequate hydration is crucial before SWL to improve the effectiveness of the shock waves in breaking down the stones. Patients are often advised to drink plenty of water before the procedure

Procedure of Shock Wave Lithotripsy

The patient is positioned on the operating table, and a soft, water-filled cushion is stationed on the abdomen or behind the kidney, which helps the high-frequency waves to be transmitted to the kidney. The healthcare provider uses an imaging technique, such as ultrasound or fluoroscopy, to locate and precisely target the kidney stone. High-energy shock waves are then generated externally and focused on the stone. These shock waves pass through the skin, muscles, and tissues, shattering the stone into smaller fragments. The entire procedure usually lasts between 30 minutes to an hour, depending on the size and number of stones.

The patient is positioned in such a manner that the shock waves would be directed precisely at the target. Usually, the procedure takes about 45-60 minutes and around 1000-3000 shock waves to crush the stones.

At times, the physician slides a tube (Double J-stent) through the bladder and threads it up to the kidney. These tubes, also called stents, are used to keep the ureter open. It is also used when there is a high risk of infection, or the patient is not able to tolerate the pain. Post-treatment, the patient is generally allowed to leave after an hour. Patients are advised to consume lots of fluids and then are asked to strain their urine through a filter in order to capture the stone fragments for testing.

The cost of lithotripsy in India varies with the type of procedure selected, the facility where the treatment takes place, and the city where the patient decides to get the procedure done.

Risks and Potential Complications

Although rare, shock wave lithotripsy may carry some risks and potential complications, including:

• Pain or Discomfort: Patients may experience discomfort or pain during the procedure, which can be managed with local or general anaesthesia and pain medications
• Bleeding: In some cases, bleeding around the kidney or within the urinary tract may occur. This usually resolves on its own but may require additional medical intervention
• Infection: There is a small risk of developing a urinary tract infection following SWL. Patients are often prescribed antibiotics to minimise this risk
• Injury to Surrounding Organs: In rare instances, the shock waves may cause injury to nearby organs or tissues, such as the liver or bowel

What to Expect After Shock Wave Lithotripsy?

Post-treatment, the patient might experience abdominal pain and will possibly have blood in the urine. Some may even experience acute pain when the stone fragments pass through urine. Sometimes, the stone present is not entirely crushed, and further treatment is needed. Patients are advised to contact the doctor for any complications post-treatment, such as the urge for urination after the bladder is empty or severe pain even after having painkillers.

Post-Operative Measures

After undergoing shock wave lithotripsy, patients are typically advised to:

• Hydrate: Drinking an increased amount of water helps flush out the stone fragments from the urinary system and reduces the risk of complications
• Pain Management: Over-the-counter or prescribed pain medications may be recommended to manage any discomfort or pain after the procedure
• Follow-Up Imaging: A follow-up imaging test, such as an X-ray or ultrasound, is usually scheduled to evaluate the effectiveness of SWL in fragmenting the stones and check for any residual fragments
• Lifestyle Modifications: Have a balanced diet, exercise regularly, and keep the body hydrated to prevent the formation of new kidney stones

Success Rate of Shock Wave Lithotripsy

The success rate of SWL depends on various factors, including stone size, composition, location, and patient characteristics. On average, shock wave lithotripsy achieves a stone-free status in about 70-90% of cases. Larger stones and those composed of certain materials, such as cystine or calcium phosphate, may have a lower success rate. However, repeat SWL sessions or alternative treatments can often be considered to achieve successful stone clearance.

Follow-up Care After Laser Lithotripsy

Patients are advised to consume around three litres of fluids per day in order to help the passage of stone fragments. If there are not any complications associated with SWL, patients are instructed to meet the physician after one month of the treatment. A kidney, ureter, and bladder X-ray is advised prior to seeing the physician as it helps him evaluate the condition. Simple analgesics are usually required after the treatment. Only in certain cases are stronger medications prescribed.

Shock wave lithotripsy is a safe and non-invasive treatment option for kidney stones. It offers several advantages over traditional surgical interventions, such as reduced risk of complications, shorter recovery time, and high success rates. Although SWL may not be suitable for all types and sizes of stones, it remains a widely used and valuable technique in managing kidney stones.

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