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TO PRO VIDE THE V ION E RY B E CC A S O Y R E ST C ARE FOR E ACH PAT I E N T O N E V 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. 2 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. 3 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. 4 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 5 • 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 6 • 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. 7 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 © The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests www.pat.nhs.uk