ESWL is an acronym for extracorporeal shock wave lithotripsy. For stones that are not accessible or a Litholyse when a stone resolution fails, the shock wave therapy is used. When the shock wave therapy, the stone is shattered. The debris will be excreted naturally. First used in 1980, it applies today as the dominant form of treatment. Treatment of urinary stones need to be treated with ESWL to 90 percent. The success rate after three months at about 80 percent.
The urine flow must be ensured by frequent catheter or a ureteral stent
Frequently accompanying measures are needed to ensure that the urine flow. This example includes a catheterization of the renal tissue or a urine ladder splint. May not be applied to shock wave therapy for coagulation disorders, use of antiplatelet agents or anticoagulants (increased bleeding risk for all three), with an acute bacterial kidney or urinary tract infection, with constrictions in the upper urinary tract and during pregnancy.
Large stones and rocks of unknown location can not be treated with ESWL
Although in principle applicable in the entire urinary tract, there are also limitations of ESWL. Urinary stones and cystine stones very large (about 2 centimeters), are not accessible to the therapy. The same goes for stones that can not be located precisely. Here, the device can be used purposefully. In such a case can be made to move carefully with the help of a catheter to the stone in a better position locatable.
The body has the same resistance, like water. A urinary but not
In ESWL, shock waves are generated which are pooled there, where the stone is located. In this way the stone is shattered. The principle is simple: Shock waves continue without interruption as long as they are in a medium of the same impedance (= characteristic impedance). Because the body has almost the same impedance as water, the shock waves from the water, where they are produced freely, invading the body and there passed away. Meet the shock waves but on boundaries with different impedance, such as a urinary stone, it comes within the stone and at its interface with development of different pressure, train and shear forces. These destructive forces acting on the stone and lead to its destruction.
The shock waves are focused onto a focal point
The shock waves are electrical discharges generated in water and then focused by a "shock-wave mirror" in a focus. The sparks are harmless to humans, because they come with the body not in contact. Previously, patients had this in a water bath be stored. With the newer devices that shock waves through electromagnetic or piezoelectric elements are generated, and the introduction of the waves into the body via a water cushion and applied to the skin gel.
The treatment lasts between 30 and 60 minutes
The location of the concentration of rays (focus or focal point) is determined using X-ray or ultrasound locating. The individual shall be positioned so that the waves in the body where they exert their greatest strength, the location of the stone. On their way through the body tissues, they cause no damage. The correct position of the urinary stones relative to the focal point of this wave is continuously monitored during lithotripsy (using either X-ray or ultrasound). The duration of treatment is between 30 and 60 minutes. Normally no more than 2000-3000 shock waves are administered. In addition, there is the risk of tissue damage. Those affected will receive a sedative and pain medication or epidural anesthesia. Only in exceptional cases, general anesthesia is performed.
There are uncommon complications. Slight tissue damage to disappear within a few weeks
The side effects and complications of ESWL are low. By the shock waves is always damaged to a lesser extent the kidney tissue. Therefore it comes to the treatment not only to a natural decline of shattered stone fragments, but also in minor bleeding, which can be detected as hematuria. even slight bleeding on the skin may occur. These effects disappear within a few weeks. Also occur in about 30 percent of these patients after lithotripsy of colic caused by the outgoing stones. Rarely, urinary retention, which must be relieved by means of drainage. Shock waves can sometimes lead to rhythm disturbances. For this reason, the shocks are correlated ECG performed. The frequency of the shock wave impact on the heart rate is adjusted so that the waves can not mess up the rhythm.
Worldwide, after several millions of ESWL treatments were no chronic damage caused by this treatment are observed.
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