EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Patients that are not successfully treated with ESWL may be treated by rigid and/ or flexible Ureteroscopy or Percutaneous Nephrolithotripsy.
Our protocol for ESWL is to thoroughly examine the patient before the session with proper imaging, and to obtain a negative urine culture. If there are signs of collecting system distention (hydronephrosis), placing a pigtail before ESWL is considered, as with stones ≈ 2cm. Patients receive analgesia throughout the session to maximize their comfort. Since the beginning of our experience with ESWL, in March 2006 we have treated a large number of patients of Western periphery of Greece and Peloponnese. More than 5.000 sessions have been performed until today.
Introduction
Extracorporeal shock wave lithotripsy (ESWL) was introduced in 1980, as an alternative, minimally invasive method of urinary stone fragmentation. Early devices required the patient to stay immersed in a water bath in order to obtain better energy transfer to the patient. Later on, as the technology developed, this was not required, and patients lie comfortably on a bed and the shock generating head is coupled to the patient through a gel filled cushion.
Following the European Urological Association Guidelines, our indications for ESWL are:
- Stones
- Proximal ureter
- Mid ureter
- Distal stones
- Occasionally for ureteral stones in all locations >10mm, with a higher probability of retreatment or progression to URS / PCNL