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Know What ESWL Is

ESWL or extracorporeal shock wave lithotripsy is one of the procedures used to treat kidney stone disease. Through ESWL, kidney stones or a collection of mineral compounds and salts that accumulate in the kidneys can be removed without surgery (noninvasive). ESWL uses a tool that can emit shock waves. This shock wave is concentrated around the kidney which is useful for breaking up kidney stones into smaller fragments so that it can be excreted with urine. This procedure is quite effective in destroying kidney stones with a diameter of less than 2 cm. The removal of deposits of more than 2 cm in diameter will be recommended through other kidney stone procedures.

ESWL indications

As mentioned above, the ESWL procedure is used to treat kidney stone disease. Kidney stones are characterized by urine containing mineral compounds that crystallize or accumulate in the kidneys. These mineral deposits are generally formed from calcium, ammonia, uric acid, or cysteine. Factors that increase a person's risk of suffering from kidney stones are:
  • Obesity.
  • Dehydration. Low intake of fluids in the body due to poor drinking patterns.
  • The wrong diet. Eating patterns by consuming excessive protein, salt or sugar.
  • Impaired absorption of water and calcium. Inflammatory bowel disease, chronic diarrhea, and a history of gastric surgery can interfere with the process of absorption of water and calcium. This condition risks increasing the formation of kidney stones.
  • Family health history. Someone who has a family with a history of kidney stones at risk of suffering from the same disease.
  • Other conditions, such as hyperparathyroidism and urinary tract infections.
Warning:
  • ESWL is not recommended for pregnant women and patients with urinary tract infections, kidney deformities, kidney cancer, abdominal aortic aneurysms, blood clotting disorders, or hypertension that is not well controlled.
  • ESWL is not effective in obese patients. In addition, ESWL is also ineffective in dealing with kidney stone deposits that are formed from cysteine ​​content and are quite large (over 2 cm in diameter).
  • Tell your doctor if you are taking blood-thinning drugs, such as aspirin or warfarin.
  • Tell your doctor when using a pacemaker or a device to stimulate the heart rate with high-voltage electricity (ICD). ESWL can damage the implants that are implanted in the organ.

Before ESWL

Doctors can advise patients to stop taking blood-thinning drugs one week before ESWL. Do not stop using the drug suddenly if it has not been recommended by a doctor. In ESWL using general anesthesia or general anesthesia, patients are advised to fast for 6 hours before the procedure is performed. Patients should be accompanied by family or closest relatives when doing ESWL, until the condition is completely recovered after general anesthesia.

ESWL Procedure

ESWL is performed without an incision or surgery, so it is often applied as an outpatient or one day care (ODC) procedure. The old ESWL method applied immersion of body parts in a tub of warm water (lukewarm). While in the latest ESWL method, patients will be asked to lie comfortably in the operating room. A soft pillow will be placed around the abdomen or the back of the kidney. The patient's body position is adjusted to the range of the ESWL device so that shock waves can be easily targeted to the area around the kidney. The doctor will give an anesthetic (anesthetic) which is adjusted to the patient's condition, usually local or half body. After administration of anesthesia, the doctor will use X-rays to determine the exact location of kidney stones. Through the ESWL tool, the urologist will provide 1000-2000 shock waves that are focused on kidney stones. This shock wave will destroy kidney stone deposits into smaller pieces, so that they can be excreted with urine. In some cases, the doctor will perform a stenting technique or insert a tube (DJ stent) from the urinary hole through the bladder to the kidney before the ESWL starts. This technique is used in patients who experience severe pain symptoms, blockage in the kidney's channel to the bladder (ureter), risk of developing urinary tract infections, and decreased kidney function. The overall ESWL procedure generally lasts for 45-60 minutes.

After ESWL

Patients will be asked to rest for 1-2 hours in the hospital. Under certain conditions, doctors advise patients to stay overnight in the hospital. The patient is allowed to go home after his condition has completely recovered. Doctors can give antibiotics and pain medications after ESWL. Some studies say the use of drugs such as alpha-blockers and calcium antagonists can facilitate the removal of broken kidney stones. Patients who are allowed to go home are asked to rest for 1-2 days and drink plenty of water for several weeks. Consuming more water can trigger urination more often, thus helping to dispose of broken kidney stones through urine. Generally, the doctor will ask the patient to use a urine filter when urinating. This filter is useful for taking samples of crushed kidney stones so that they can be further examined in the laboratory.

ESWL Risks and Complications

After undergoing ESWL, patients may experience complaints in the form of urine containing blood, discomfort in the lower back, and pain during urination. Pain that is felt can last for 4-8 weeks. This is normal and common. In addition, there are also other complications that rarely occur, including:
  • Crystal deposits re-form in the patient's kidney, so doctors will advise patients to undergo further EWSL or other procedures.
  • Infection.
  • Kidney bleeding.
  • A bruise on the back back.

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