What is ESWL and how does it crush stones?
Extracorporeal shock wave lithotripsy is the gold standard for the treatment of small kidney and upper ureteral stones. A lithotripter machine generates shock waves outside the body (extracorporeally) and focuses them on the stone with an accuracy of a few millimeters. The waves pass freely through soft tissue and release energy only at the tissue-stone interface: during a session, the stone receives 2,000–3,500 impulses and crumbles into fragments the size of a grain of sand.
Guidance is performed under ultrasound or x-ray control, so the doctor sees the stone in real time and adjusts the focus. Unlike contact methods, with ESWL no instruments are introduced into the body: there are no cuts, punctures or stitches, and recovery takes a matter of days.
Indications: which stones can be crushed remotely
- kidney stones ranging in size from 5 mm to 2 cm (the best result is 0.5–1.5 cm);
- stones of the upper and middle third of the ureter up to 1–1.5 cm;
- small bladder stones;
- stones with a density according to MSCT up to 1,000 HU - denser ones (oxalate, cystine) are crushed worse;
- residual fragments from other kidney surgeries.
Small stones up to 4–5 mm usually pass on their own due to drinking regimen and medications, so the urologist first evaluates whether the procedure is necessary at all. Stones larger than 2 cm and coral stones are more effectively removed by percutaneous nephrolithotripsy, and stones of the lower third of the ureter are removed by contact laser lithotripsy through an ureteroscope.
Contraindications
- pregnancy;
- blood clotting disorders and taking anticoagulants that cannot be canceled;
- acute pyelonephritis or active urinary tract infection - treat the infection first;
- narrowing of the ureter below the stone, due to which fragments cannot pass;
- aneurysm of the aorta or renal artery in the focal area;
- severe obesity, when the distance from the skin to the stone exceeds 10–12 cm;
- uncontrolled arterial hypertension.
Preparation for the procedure
Before ESWL, the urologist prescribes an examination that determines the tactics: ultrasound of the kidneys and bladder, plain radiography and MSCT without contrast - it is tomography that shows the exact size, position and density of the stone. Tests require a general blood and urine test, a coagulogram; if infection is suspected, urine culture is performed. If necessary, an ECG and consultation with an anesthesiologist are performed.
For 2-3 days, eliminate foods that cause bloating (legumes, cabbage, brown bread, carbonated drinks) - gas in the intestines interferes with induction. Come on an empty stomach: last meal 4-6 hours before. Tell your doctor about all medications you are taking - aspirin and other blood thinners should be discontinued 5-7 days in advance in consultation with your doctor. Women of childbearing age should exclude pregnancy.
How does the session work?
The patient is positioned on the lithotripter table lying on his back or stomach, depending on the location of the stone. A water cushion of gel is applied to the skin, through which shock waves are passed. The doctor brings the stone into the focus of the machine under ultrasound or X-ray control and fires a series of pulses, gradually increasing the power.
The impulses are felt as rhythmic jolts or light beats; To make the procedure comfortable, anesthesia or light sedation is used - according to the clinic’s price list, anesthesia is paid separately. The session lasts 30–60 minutes. After this, the patient is observed for 1–2 hours and sent home; no hospitalization required.
What happens after crushing
In the first 1–2 days, there may be some blood in the urine and moderate pain in the lower back - this is a normal reaction to the passage of fragments. When fragments exit through the ureter, renal colic may occur: the doctor prescribes painkillers and drugs that relax the ureter (alpha-blockers).
The main condition for success is the drinking regime: 2–2.5 liters of water per day and moderate physical activity (walking) help the fragments come out faster. Complete withdrawal takes from several days to 3–4 weeks. Control ultrasound is performed after 1–2 weeks; if large fragments remain, a repeat session is prescribed with an interval of 10–14 days. For large stones, a ureteral stent is sometimes installed before the procedure to prevent the “stone path” from blocking the flow of urine.
Efficacy and possible complications
For stones up to 1 cm in the kidney, complete stone removal after one or two sessions is achieved in 70–90% of patients; for stones of 1–2 cm and high density, the indicator is lower, and up to three sessions may be required. The result depends on the size, density and location of the stone, as well as on the anatomy of the kidney - therefore, preliminary MSCT is required.
Complications are rare: a small kidney hematoma, exacerbation of infection, temporary obstruction of the ureter with fragments. All of them are controlled by observation and treatment. To reduce risks, do not hide your medications, past infections, and chronic diseases from your doctor.
ESWL or contact crushing: what to choose
Remote lithotripsy is the most gentle method: without anesthesia, without instruments inside, on an outpatient basis. It is chosen for small kidney stones and the upper third of the ureter. Contact laser lithotripsy through a ureteroscope gives almost 100% results in one session for ureteral stones, especially in the lower third, but is performed under anesthesia. Percutaneous nephrolithotripsy through a puncture in the lower back is a method for large (more than 2 cm) and coral stones. All three methods are available in urological clinics in Tashkent; The final choice is made by the urologist based on the results of MSCT.
ESWL in Tashkent: where to do it and how much it costs
This page contains a collection of Tashkent clinics where they perform remote lithotripsy using modern lithotripters with ultrasound and X-ray guidance, as well as official prices according to the clinics’ price lists. The cost of the session, as a rule, does not include anesthesia and preliminary examination (ultrasound, MSCT, tests) - they can be completed in the same clinic. To make an appointment, select a clinic below: on its page there is a telephone number, opening hours and an online appointment for a consultation with a urologist.
