Lithotripsy for Kidney Stones
Dayton Physicians Network urologists offer a wide array of treatments for many different urological conditions.
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method used to treat urolithiasis (urinary tract stones) using an acoustic pulse. It is estimated that over one million patients are treated per year with lithotripsy.
Fluoroscopic x-ray imaging is used to locate the stone and aim the treatment, and the acoustic pulse is aimed at the focal point corresponding to the location of the stone. ESWL works best with kidney stones between 4-20 mm in diameter which are located in the kidney. It can be used to break up stones located in the ureters, but with a lower rate of success.
A number of clinical studies report that slowing the firing rate of the lithotriptor to 60 shock waves (SW) per minute gives better outcomes than treatment at the typical rate of 120 SW per minute. The advantage of slowing the SW rate is that fewer shock waves are needed for treatment, but a potential disadvantage is a modest increase in overall treatment time. In addition, studies have shown that slowing the Shock waves rate and starting with lower power of treatment results in a reduction in renal injury during ESWL. Renal &Urology News, August 2015
Recent studies have shown that increasing the rate to 90 SW per minute for ureteral stones can improve the stone clearance rate, from 83% to 100% for proximal stones, and 73% to 96% in mid-ureteral stones. No change in stone clearance rates were seen for distal ureteral stones. There has been a decrease in popularity of ESWL for ureteral stones due to advances in technology, which has resulted in more ureteral stones being treated ureteroscopically, this may be relevant, as it indicates that optimizing the SW delivery rate can achieve excellent outcomes for proximal and mid-ureteral stones.
As a non-invasive treatment option for management of urolithiasis, ESWL usually results in less post-operative pain and an earlier return to normal activity as compared to ureteroscopic management, and should be included in the complete discussion of treatment options for patients with urolithiasis who are seeking treatment.
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