Download Extracorporeal Shock Wave Lithotripsy (ESWL)

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Extracorporeal Shock
Wave Lithotripsy
(ESWL)
An information guide
Extracorporeal Shock Wave Lithotripsy
(ESWL)
What is the procedure?
Extracorporeal shock wave lithotripsy (ESWL) has been used in the
management of stones in the kidneys and ureters (tubes from the
kidney to the bladder) for the past twenty years.
The lithotripsy machine generates shockwaves from an
electroconductive device. This energy is then focused and
magnified using “acoustic lenses” which can be directed at your
kidney stone. By focusing the sound energy in this manner, a shock
wave can be produced at a point on the stone with enough power
to cause fragmentation of the stone. A large number of small shock
waves are generated and directed at different parts of the stone, to
facilitate the fragmentation without causing discomfort to the
patient.
What are the alternatives?
Your specialist will have already discussed alternative treatment
options for your kidney stones with you, and ESWL is the preferred
option to clear them. If you leave the stones as they are without any
treatment they may grow larger and cause more complications.
Why do I need an operation?
To clear the stones from your urinary tract and to prevent them
from becoming larger or infected; clearing them will allow your
urinary system to drain freely.
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Can everyone have lithotripsy?
• if you have a pacemaker please inform your specialist
• you will need to be reviewed by your heart doctor as the
treatment can interfere with your pacemaker
• if you are over 120kgs (19 Stone) in weight lithotripsy cannot be
carried out due to the weight restriction of the machine
• it is not advisable for pregnant women. If you think you may be
pregnant please inform your specialist, or the nursing staff in the
preoperative assessment clinic or on the unit
• it is not advisable for patients with some bleeding disorders and
patients known to have an aortic aneurysm. If you have any of
these conditions please inform your specialist.
Possible risks
All procedures carry risks, Complications can develop during or
after the procedure. Every effort is made to prevent, recognise and
treat these.
• there is a very small risk of bleeding
• infection
• the stone might not be broken up
• the ureter might be perforated
• develop ureteric obstruction which may need intervention.
Fragments from the kidney stone usually pass down the ureter into
the bladder and can then be passed out in the urine.
If the fragments are too large, they can get stuck in the ureter and
cause symptoms of pain, with the potential risk of infection. You
may need a stent (tube) inserted prior to lithotripsy to prevent any
blockages like this.
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Occasionally stones can harbour infection, and lithotripsy can
release bacteria into the urinary tract causing urine or blood
infections. You will be given intravenous antibiotics prior to the
treatment and will continue with oral antibiotics for the next 5 days
at home. Please ensure that you receive a course of antibiotics and
painkillers before you leave the Day Surgery Unit, and that you
complete the full course of antibiotics. If you experience problems
when taking any of the medications given to you, please consult
your GP for further advice.
If you feel unwell or develop a fever after discharge, you should
contact your GP for urgent advice, or alternatively attend the
Accident and Emergency Department.
What are the benefits
Having the treatment will fragment the stone, to allow it to pass
spontaneously and naturally out of the kidney.
Since this procedure is carried out under sedation you are usually
only in hospital for a few hours, as your recovery time is quicker
than having a general anaesthetic. However some patients do
require an overnight stay. Your specialist will inform you if this is
required when your session is booked.
Before the operation
• you will be asked to attend the pre-operative assessment clinic
where tests such as ECG (heart tracing), x-ray, urine and blood tests
may be carried out
• you will be advised when to stop eating and drinking before your
operation, this is usually 4 hours prior to your appointment
• if you are taking anticoagulants (blood thinning drugs such as
warfarin, aspirin or sinthrone) please inform the preoperative
assessment staff.
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What happens on your admission day?
• you will be asked relevant information by the nurse and a doctor
• on admission to the Day Services Unit relatives or friends will be
unable to stay with you, except in certain circumstances where
prior arrangements can be made with the ward manager. Please
contact the unit directly to arrange this
• your operation will be explained to you and you will be asked to
sign a consent form, if you have not already done so
• you will be asked to provide a urine sample to ensure there are no
signs of infection
• your blood pressure, pulse and temperature will be recorded.
What happens during the procedure?
• a lithotripsy session normally takes about one hour
• you will be transferred to the theatre complex to the lithotripsy
suite
• you will be transferred from your trolley onto a large table or you
may walk to theatre and climb onto the table
• you may require oxygen during the procedure
• a radiographer (x-ray technician) will position you correctly so
that the stone is in the correct position and that your skin is
touching the machine
• an intravenous cannula (tube) will be inserted into your arm so
that antibiotics, pain relief and sedation can be given
• through this cannula you will be given intravenous fluids to help
flush out the fragments of the stone
• when the procedure commences you will a loud clicking noise,
you must remain in contact with the machine at all times
• it is important you remain still throughout the session. If you have
any problems please raise your hand
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• the clicking noise will get louder as the power is increased if you
find it uncomfortable please let the person standing with you
aware of this, and it can be reduced
• if you experience a lot of pain please make the specialist aware so
you can be given more pain relief if required.
What happens after your operation?
• you may require oxygen following your operation
• your blood pressure, temperature, pulse and respiration rate will
be recorded by the nurse
• you may experience some pain and discomfort after the
treatment. Pain relief will be provided by the nurses
• you should be able to eat and drink normally once the sedation
has worn off.
When you are ready to go home
• you may experience some discomfort for a few days following this
procedure. You will be given some pain relief on discharge to take
home. However if it persists contact your GP for advice
• you will notice a red area on your skin where the treatment has
been given. This is normal and will clear in a few days
• you may have some discomfort when passing urine and see blood
in your urine following the treatment.
You are advised to :
• take simple painkillers, which you will be given on discharge
• drink extra fluids, water or cordial (2.5 litres – 3 litres) for 2 days
then return to normal drinking habits. However to prevent stone
recurrence you are advised to continue to drink 2.5 litres of fluid
every day
• you will be given antibiotics. You must ensure you complete the
course
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• your doctor and the nurses will discuss with you when they are
happy for you to go home
• following the session the fragments of the stone will continue to
pass through your system. Please ensure you drink at least 2.5 litres
of fluid daily to flush the stones out and prevent infection, this will
also reduce the discomfort as the fragments are passed
• you may have been asked to stop taking some medication before
your operation. If so, please ask your hospital doctor about
restarting these
• if you require a fit note to cover your hospital stay, please ask the
nurses on the ward. Any further fit notes can be obtained from your
GP
• your consultant will arrange the appropriate follow-up for you
which may be another lithotripsy session or to be seen in the
outpatients’ department
• you may feel tired for a few days after the operation but this will
gradually improve.
If you are discharged on the day of your treatment you are advised.
• not to return to work
• not to sign any important documents
• not to drive, as your insurance will be invalid
• you will need to have a responsible adult to look after you. They
will also need to accompany you home after your operation and
will need to pick you up from the unit. This will be discussed with
you at the pre-operative assessment clinic.
If you are worried or have problems after your discharge, contact
your GP or telephone the ward for advice. In an emergency, go to
the nearest Accident and Emergency Department.
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If English is not your frst
language and you need help,
please contact the Ethnic Health
Team on 0161 627 8770
Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować
się z załogą Ethnic Health pod numerem telefonu 0161 627 8770
For general enquiries please contact the Patient
Advice and Liaison Service (PALS) on 0161 604 5897
For enquiries regarding clinic appointments, clinical care and
treatment please contact 0161 624 0420 and the Switchboard
Operator will put you through to the correct department / service
Date of publication: April 2008
Date of review: February 2014
Date of next review: February 2017
Ref: PI_SU_434
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