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Urology

  • Shock Wave Lithotripsy

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.

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