Risks and Side Effects of Shock Wave Lithotripsy for Kidney Stones
Shock wave lithotripsy (SWL) is used best only to treat smaller stones that are located inside the kidney or upper part of the ureter. The stone’s size, existing medical conditions, and body structure have to fit into the eligibility criteria for shock wave lithotripsy compared to the latest advanced techniques available at Kidney stone treatment Chennai. Kidney stones can be significantly treated with advanced stone breakage and removal techniques that have been more recently developed. However, people still value shock wave lithotripsy because it is the only non-invasive means to remove stones. Having said that, people are unaware that shock wave lithotripsy is likely to be linked to several potentially serious side effects that could adversely cause acute or chronic health hazards.
Acute side effects of shock wave lithotripsy for kidney stones – Shock wave lithotripsy employs high-energy acoustic pulses (shock waves) generated outside the body to break stones within the kidney and ureter. Stone breakage by SWL is a progressive process that repetitively subjects the body to hundreds to thousands of SWs. The most significant disadvantage of this technique is that it does not involve visual localisation and extraction of the stones.
Extracorporeal shock wave lithotripsy (ESWL) is the most common type of lithotripsy. During ESWL, a particular machine called a lithotripter generates the shock waves that travel through the body to reach the kidney and break apart the stones. After the procedure, the broken-down stone debris is expelled from the kidneys or ureter through urination. The physical mechanism of shock wave application to break the stones can also cause SWL injury. The side effects of SWL throughout recovery can be experienced as:
- Blockage in the ureter – ureteral obstruction could occur if the mass of stone debris were too high to be cleared through urination after SWL.
- Tissue injury – The mechanisms of SWL involved in stone breakage are the conditions that can lead to tissue injury. The same features of the lithotripter acoustic field that contribute to stone breakage are also involved in generating tissue damage within and around the kidneys, leading to bleeding. All patients who undergo SWL for renal stones exhibit haematuria after receiving SWs. SWL injury to the kidney is primarily a haemorrhagic vascular lesion. There is evidence that SWs rupture blood vessels and can damage surrounding renal tubules in the kidney.
- Infection – After SWL, minute residual fragments that harbour bacteria and cause persistent bacteriuria can remain in the renal collecting system for months.
- Discomfort or bruising on the back – Reports of damage outside the kidney are noteworthy and may be an additional cause for concern. Perforation of the colon, rupture of the hepatic artery, hepatic hematoma; pneumothorax, rupture of the spleen, acute necrotizing pancreatitis, dissecting abdominal wall abscess, rupture of the abdominal aorta, and iliac vein thrombosis are some of the damages that can occur due to SWL.
- Painful urination – Lingering pain during urination after passing a kidney stone could signify that you have another stone, an obstruction, or an infection.
- Kidney stone recurrence – stone fragments left behind can serve as foci for the development of new stones; hence stone-free rates are lower, and stone recurrence rates are higher for SWL than with minimally invasive techniques such as ureteroscopy and percutaneous nephrolithotomy that involve visual localization and extraction of stones at Best hospital for kidney stone treatment in Chennai.
Chronic side effects of shock wave lithotripsy for kidney stones – A variety of severe complications, including irreversible acute renal failure, can occur from bleeding or even in the absence of excessive bleeding after SWL. The incidental mild to severe haemorrhage caused by damage to blood vessels by SWs can initiate an inflammatory response and a cascade of events that lead to scar formation. These manifestations ensue as a chronic injury.
Other chronic adverse effects of SWL may include:
Exacerbation of stone disease – A correlation has been observed to exist in the possibility that SWL is linked to a transition from Calcium oxalate stone disease to brushite stone disease, which is a change towards a more complicated stone disease. This implies that multiple lithotripsies for the treatment of calcium oxalate stones may cause progressive injury in the kidneys that alter the normal physiology of the collecting ducts and fuel the formation of brushite stones. This mineral type does not respond well to SWL.
New-onset hypertension – A potential long-term consequence of SWL is the development of hypertension. Age seems to be a significant risk factor as the intrarenal resistive index in patients 60 years and older increases. Several studies have reported an increase in hypertension among older lithotripsy patients resulting from the formation of renal hematomas.
Organ damage – Organs other than the kidney will be subjected to stresses sufficient to cause injury during SWL. Though the acoustic energy from the lithotripter is targeted within its focal zone, the limits of high acoustic pressures generated by the SWs are not limited to this region. The focal zone is the area that contains the highest acoustic pressure and highest energy density. Still, SW pressures of the pulse can be relatively high outside this volume, subjecting the neighbouring organs to damage. Thus, the occurrence of injury to the bowel, liver, spleen, or some other organ after SWL does not necessarily mean that the lithotripter was targeted incorrectly.
Risk of developing diabetes mellitus – On mechanistic grounds of the idea that the pancreas could be an organ that can get damaged during lithotripsy, this injury might lead to long-term effects such as diabetes.
Patients typically receive more SWs than necessary to eliminate their stones because there is no suitable method to determine when breakage is complete in SWL. Acute injury precedes lasting effects damaging renal structure and function compared to other improved techniques that are safe and effective available at kidney stone clinic in Chennai. An acute injury that occurs from repeated single, typical treatment sessions of SWL can be avoided by choosing advanced treatment methods and thus prevent severe long-term effects.
