Extracorporeal Shock Wave Lithotripsy (ESWL)

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Things you need to know

What is ESWL?

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-surgical procedure that uses high-energy shock waves to fragment kidney or ureteral stones into smaller pieces, which can then pass through the urinary tract. It’s a common treatment for kidney stones, especially those too large to pass on their own. In India, ESWL is performed in urology departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, often at affordable costs. Understanding the procedure, costs, recovery, risks, and FAQs is essential for patients.

Why do you need ESWL?

ESWL is indicated for:

Kidney stones:
- Stones 5–20 mm in size (best for stones <10 mm; 80–85% success rate).
- Stones in kidney (renal pelvis) or upper ureter.
- Composition: Calcium oxalate (most common, 70–80%), uric acid, or struvite stones (if not too hard).
- Incidence in India: 5–15% lifetime risk; higher in hot climates (e.g., North India).
Contraindications:
- Large stones (>20 mm), staghorn stones, or stones in lower ureter (better treated with ureteroscopy).
- Pregnancy, bleeding disorders, or urinary obstruction below stone.
Associated treatments:
- Often preceded by stent placement (if stone causes obstruction).
- Followed by medical expulsive therapy (e.g., tamsulosin) to aid stone passage.
Timing:
- Performed in adults (average age 30–50 years for kidney stones); urgency depends on symptoms (e.g., severe pain, infection).

The procedure aims to fragment stones non-invasively, relieve pain and obstruction, and prevent complications like infection or kidney damage, often as an outpatient procedure with minimal downtime.

Why Do ESWL Costs Vary in India?

Costs range from ₹30,000 to ₹80,000 :

Procedure Complexity: Single session (₹30,000–₹50,000); multiple sessions or complex stones (₹50,000–₹80,000).
Hospital/Location: Higher in metro cities (Apollo, Fortis: ₹50,000–₹80,000); lower in government hospitals (AIIMS: ₹10,000–₹30,000, often subsidized under Ayushman Bharat).
Sedation: IV sedation (lower cost); general anesthesia (higher cost, ₹5,000–₹10,000).
Additional Costs: Imaging (₹2,000–₹5,000), medications (₹1,000–₹3,000), stone analysis (₹1,000–₹2,000).
Insurance: Often covered (medical necessity); confirm with your provider.

ESWL Procedure

Before Procedure Evaluation:
- Assessment:
  - Imaging: X-ray, ultrasound, or CT to locate stone, assess size, and check for obstruction.
  - Urine test: Checks for infection (UTI must be treated first).
  - Blood tests: Kidney function (creatinine), blood sugar, clotting profile.
- Preparation: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; hydrate well; fasting 4–6 hours if sedation used.
- Consent: Risks, including bruising, are explained.
Procedure Technique:
- ESWL:
  - Performed under sedation (IV pain relief) or light general anesthesia, lasting 30–60 minutes.
  - Process:
    - Patient lies on a table; water cushion or gel applied to couple shock waves to skin.
    - Stone localized using fluoroscopy (X-ray) or ultrasound.
    - Shock waves generated (1,000–3,000 shocks, 1–2 shocks/second) by lithotripter machine; waves pass through body, focusing on stone to break it into fragments (<2–3 mm).
    - Fragments pass naturally via urine over days to weeks.
  - Post-procedure: Patient monitored for 1–2 hours; encouraged to drink water to flush fragments.
- Equipment:
  - Lithotripter: Generates shock waves (electromagnetic, piezoelectric, or electrohydraulic).
  - Fluoroscopy/ultrasound: Guides targeting.
  - Pain management: Sedation or analgesics (e.g., fentanyl).
After Procedure:
- Hospital stay: Outpatient (discharge after 1–2 hours).
- Care: Drink 2–3 liters of water daily to flush fragments; strain urine to collect stone pieces (for analysis).
- Pain management: Mild to moderate pain during fragment passage (1–2 weeks); managed with painkillers (e.g., diclofenac).
- Instructions: Avoid strenuous activity for 1–2 days; monitor for fever or severe pain.

Recovery After ESWL

Recovery Time: Same-day discharge; recovery from discomfort takes 1–2 days.
Post-Procedure Care:
- Pain: Mild to moderate colicky pain as fragments pass (1–2 weeks); managed with painkillers.
- Urine: Blood-tinged urine (hematuria) for 1–3 days; clears with hydration.
- Activity: Resume normal activities in 1–2 days; avoid heavy lifting for 1–2 days.
- Stone passage: Fragments pass in 1–4 weeks; 80–85% clear within 1 month (depends on size, location).
Follow-Up:
- Visit at 1–2 weeks to confirm stone clearance (X-ray or ultrasound).
- Repeat ESWL (10–20% of cases): If fragments remain or stone doesn’t break adequately.

Most resume normal activities in 1–2 days; full stone clearance takes 1–4 weeks. Success rate: 80–85% for stones <10 mm; 50–60% for 10–20 mm; multiple sessions may be needed for larger stones.

Risks and Complications

Procedure Risks:
- Pain (20–30%): During shock wave delivery; managed with sedation or analgesics.
- Bruising (10–20%): At shock wave entry site (back or abdomen); resolves in 1–2 weeks.
- Hematuria (30–40%): Blood in urine; usually mild, resolves in 1–3 days.
Post-Procedure:
- UTI (2–5%): Risk of infection from stone fragments; managed with antibiotics.
- Steinstrasse (5–10%): “Street of stones”—fragments block ureter; may need ureteroscopy or stent.
- Hypertension (1–2% long-term): Rare; possibly from kidney trauma.
- Failure (15–20%): Stone doesn’t break (hard stones, e.g., cystine); may need alternative (e.g., ureteroscopy).
Long-Term:
- Recurrence (30–50%): Kidney stones often recur within 5–10 years; needs dietary changes and monitoring.

Report fever, severe pain, inability to urinate, or persistent hematuria promptly.

Frequently Asked Questions (FAQs)

What causes the need for ESWL?

Kidney or ureteral stones (5–20 mm) causing pain, obstruction, or infection.

Can I avoid ESWL?

Yes, if small stones (<5 mm): Hydration and medical expulsive therapy (e.g., tamsulosin); ESWL needed for larger stones or persistent symptoms.

Is ESWL painful?

Mild to moderate discomfort during procedure (sedation helps); colicky pain during fragment passage (1–2 weeks).

How soon can I resume normal activities?

Normal activities: 1–2 days; full stone clearance: 1–4 weeks; avoid strenuous activity for 1–2 days.

Is ESWL covered by insurance in India?

Often covered (medical necessity); confirm with your provider; Ayushman Bharat often subsidizes.

Signs of complications?

Fever, severe pain, inability to urinate, or persistent hematuria.

Will all stones be cleared after one session?

Not always: 80–85% clear with one session (stones <10 mm); larger stones may need repeat sessions or alternative procedures.

Lifestyle changes post-procedure?

Hydrate (2–3 liters/day), reduce salt/oxalate intake, monitor for recurrence, and attend follow-ups.

Conclusion

ESWL is a safe, non-invasive procedure for treating kidney stones, with high success rates for smaller stones and minimal recovery time. India’s top hospitals (Apollo, Fortis, AIIMS) provide affordable care, often covered by insurance. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach it confidently. Consult a urologist for personalized guidance.

Looking for Best Hospitals for ESWL

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City	Minimum Price (₹)	Maximum Price (₹)
Agra	30,000	80,000
Ahmedabad	50,000	1,00,000
Ajmer	30,000	80,000
Aligarh	30,000	80,000
Allahabad	30,000	80,000
Amritsar	40,000	90,000
Aurangabad	40,000	90,000
Bangalore	50,000	1,00,000
Bareilly	30,000	80,000
Belgaum	40,000	90,000
Bhopal	40,000	90,000
Bhubaneswar	40,000	90,000
Bikaner	30,000	80,000
Chandigarh	50,000	1,00,000
Chennai	50,000	1,00,000
Coimbatore	50,000	1,00,000
Dehradun	40,000	90,000
Delhi	50,000	1,00,000
Dhanbad	30,000	80,000
Durgapur	30,000	80,000
Faridabad	50,000	1,00,000
Ghaziabad	50,000	1,00,000
Gorakhpur	30,000	80,000
Guntur	40,000	90,000
Gurgaon	50,000	1,00,000
Guwahati	40,000	90,000
Gwalior	30,000	80,000
Hyderabad	50,000	1,00,000
Indore	40,000	90,000
Jabalpur	30,000	80,000
Jaipur	50,000	1,00,000
Jalandhar	40,000	90,000
Jamshedpur	40,000	90,000
Jodhpur	30,000	80,000
Kanpur	30,000	80,000
Kochi	50,000	1,00,000
Kolkata	50,000	1,00,000
Kollam	40,000	90,000
Lucknow	40,000	90,000
Ludhiana	50,000	1,00,000
Madurai	40,000	90,000
Mangalore	40,000	90,000
Meerut	30,000	80,000
Moradabad	30,000	80,000
Mumbai	50,000	1,00,000
Mysore	50,000	1,00,000
Nagpur	40,000	90,000
Nashik	40,000	90,000
Navi Mumbai	50,000	1,00,000
Noida	50,000	1,00,000
Patna	30,000	80,000
Pune	50,000	1,00,000
Raipur	40,000	90,000
Rajkot	40,000	90,000
Ranchi	30,000	80,000
Surat	50,000	1,00,000
Thane	50,000	1,00,000
Vadodara	40,000	90,000
Varanasi	30,000	80,000
Visakhapatnam	40,000	90,000

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.