Shock Wave Lithotripsy—
The First Line of Treatment for Kidney Stones
Kidney stone pain can be unforgettable with severe cramping that starts in the back and shoots to the side or groin. Each wave of discomfort is a frightening reminder that sooner or later, this stone will need to come out. What happens if it won’t pass naturally or can’t be dissolved with medications?
Thanks to a non-invasive technique called extracorporeal shock wave lithotripsy (ESWL), people no longer need to fear kidney stones. With ESWL, carefully directed shock waves pass harmlessly through the body and hit the stone, causing it to crumble into sand-like particles. These shattered particles can then pass easily out of the urinary tract. With this technology, patients are much more comfortable during the procedure and can return to regular activities much quicker than traditional surgery.
“In selected patients, lithotripsy is very effective,” said Urologist Marc L. Nierman, MD. “It’s non-invasive, and particularly with the smaller stones, it’s much less painful. Coming to Milford for the procedure is a lot more convenient than going to Worcester or Framingham.”
According to Dr. Nierman, the patient lies on a table under IV sedation, but is usually not asleep. An X-ray or ultrasound finds the exact location of the kidney stone, and then shock waves are aimed at the stone. If awake, the patient may feel a tapping sensation. The procedure takes about thirty minutes and will be followed by a brief stay, usually up to an hour, in the recovery room. Patients are generally sent home to pass the stone naturally and are asked to strain their urine with a filter.
“Patients are given pain medication and told to drink water as they’re waiting for the stones to pass,” Dr. Nierman said. “It’s added therapy for the stones.”
By analyzing the fragments of the kidney stone, the physician can determine what caused the stone and recommend dietary changes. A stone may be as fine as dust, or as large as a golf ball. People with small stones may be told to take medication, drink water and wait for the stone to pass without lithotripsy. According to Urologist Sanjaya Kumar, MD, most stones are composed of calcium oxalate.
“The majority of stones are idiopathic with no known cause, but there are contributing factors such as dehydration, certain diseases, a family history and eating a lot of certain types of foods,” explained Dr. Kumar. “There are stone promoters in the urinary system and stone inhibitors, and if the balance is warped, stones could build.”
Dr. Kumar said that depending on the size and location of stones, after a patient undergoes ESWL, it could take days or more than a month for particles to leave the body. Two weeks after the procedure, patients return to their physician’s office for another X-ray.
“About 80 percent of stones require one treatment, but if you have a large stone greater than 1.5 centimeters and you have a very hard stone, those people may need more than one ESWL procedure,” explained Dr. Kumar.
Some patients may require invasive procedures which can be done on an outpatient basis at Milford Regional. The stone’s size, composition and location determine the best course of action. Lithotripsy is not advised for pregnant women, people with bleeding problems, or individuals on the blood thinner Coumadin.
“We use a combination of these treatment options, but ESWL because of its non-invasive nature and high success rate, is becoming the first line treatment,” said Dr. Kumar. Unfortunately, having a kidney stone once increases the risk of additional stones in the future. Depending on what caused the stone, your doctor will recommend dietary changes and increased water intake to help prevent future stones.
Sherry Burns of Franklin underwent ESWL for her second experience with kidney stones. She plans to alter her diet in order to prevent future incidents. Sherry says that the combination of lithotripsy and pain medication prevented any pain when she passed the stones a few days later, making ESWL well worth her time.
“I was only aware that the procedure was happening towards the end,” she said. “It felt like a constant tapping on my side with mild discomfort. I was nervous about it before, but wouldn't hesitate to repeat it. The procedure went a lot faster and more painlessly than I expected. I would recommend it to others.”
For more information on kidney stone treatments, call one of the following Milford Regional urologists: Sanjaya Kumar, MD or Eddie Michli, MD: 508-482-5411; Jeffrey Steinberg, MD: 508-473-6333.
