Urolithiasis / Extracorporeal ShockWave Lithotripsy (ESWL)

Дистанционная Литотрипсия

Practicing urologist probably encounters with urolithiasis and its manifestations more frequently than with other urological diseases. In Uzbekistan urolithiasis has a enough wide (you can even use the term "endemic") distribution. This is due to the peculiarities of the climate, the quality of drinking water, food culture of our region.

Most often there are questions WHERE? WHY? and HOW? do stones form in the urinary tract. These questions can be answered by viewing the content of the next clip. 


Following ways to remove stones from the urinary tract are now available.

1. Medicinal methods. This method of getting rid of the stones is the safest and preferred. The question of treatment of  kidney stones with medication and herbs, becomes relevant, if the stone is no more than 4 mm in diameter. In this case, it is able to self-discharge of. He just needs help to get out.

2. Open abdominal surgery was the only method of surgical treatment for a long period of time. It is currently difficult to say anything about the benefist of this method. Its main disadvantages are:

- high invasiveness due to the broad application of abdominal incisions;

- a number of possible intra- and postoperative complications (bleeding, wound infection, etc.) in due to, again, the broad use of abdominal incisions;

- urolithiasis has tend to repeat, so every possible following surgery after open surgery could be more difficult and dangerous;

- the appearance of cosmetic defects.

3.Endoscopic interventions. Medical technologies are constantly evolving. Nowadays, endoscopic methods of removing stones become daily practice for the operating urologist. They differs from traditional open methods of treatment with less traumatism and easier recovery. The wide dissection of tissue and muscle covers are not applicable; access to the kidney as much as possibl eare reduced. Access to the stone possible from 2 sides:

- Percutaneous nephrolithotripsy. Destruction of kidney stones with tools is performed through a puncture in the lumbar region. The stones are removed by nephroscope - a metal tube with optics. Through this tube can be supplied to different tools that destroy and remove kidney stones.

- Ureteroscopy. Cystoureteroscopy. This method is used most often in cases where the stones are located in the ureter or bladder. Access to the stone is performed through the urinary tract. Tools that penetrate to the stone and destroy it by crushing are introduced through the urethra. Methods of stone destruction are various; mechanical and laser contact lithotripsy are used.

ESWL4. Extracorporeal shock-wave lithotripsy (ESWL) is the least traumatic method. Stones are destroyed by remote influence of the shock wave. Apparatus which destroys stones is called extracorporeal lithotripter. The need for punctures and cuts isabsent. This method is the most restrictive. ESWL hase fewer complications compared with other operational and minimally invasive methods of stone treatment. This method is also cheaper than other surgery to remove kidney stones; according to estimates of US physicians, spendings are less on an average of 37%. Furthermore, it is typical shorter recovery period and shorter period of pain for ESWL. Patients after ESWL can faster return to work.

The size of the stone is definitive among the main parameters that were previously accounted as an indication for ESWL. In the early 80s the main indications for ESWL were stones up to 1.5 cm. However, modern ESWL devices allow to crush stones ranging in size from 0.5 to 2.5 cm. In recent years, it is believed that the efficiency of stone crushing depends on not the size of the stone, but its physical and chemical properties. We also note, that the ESWL method is effective in both adults and children.

Many modern ESWL devices allow to perform the procedure without anesthesia. But despite this, the majority of patients experience mild pain. As a rule, it is connected with the passage of shock waves through the skin and irritation of the nerve endings.

It should be understood that the ESWL is not a cure for kidney stones, but only destroys the existing stones. That is, the patient in this case is not protected from the fact that he has possibility of repeat stone formation. Therefore, after the ESWL session he must constantly take measures to prevent stone formation.

We practice this method of removal for the past 3 years with fairly good results. Some of them can be found in the "Cases" of our website. In our clinic session lithotripsy generally proceeds in an average of 1 hour, during which the patient can get up to 4000 shock waves. Usually, lithotripsy procedure begins with the shock waves of low energy and long intervals between pulses. This allows the patient to get used to the procedure. Gradually, the strength and frequency of shocks increases. The procedure becomes more painful if the shock waves the paths  near a bone (e.g., a rib), as the wave causes some response in bone.

Lastly, I would like to note that each stone removal method has its indications and contraindications, which the patient must be thoroughly informed by a doctor. Also, doctor should discuss the possible complications, and measures to eliminate them, no matter what method of removal of stone selected. Only mutual understanding and mutual trust of the patient and the doctor ensures the success of the treatment.

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