LITHOTRIPSY (EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY or ESWL) AN INFORMATION LEAFLET Written by: Department of Urology January 2018 Stockport: 0161 419 5698/5697 Website: w w w. s t o c k p o r t. n h s. u k Tameside: 0161 922 6696/6698 Webs ite: w w w. t a m e s i d e. n h s. u k Macclesfield: 01625 661517 Lithotripsy 1 of 7
What Is Lithotripsy (Extra Shock Wave Lithotripsy)? Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-surgical way to treat kidney stones. Ultrasound and/or x-ray screening equipment are used to provide a precise image and location of the kidney stone. Pulses of energy are then aimed at the stone causing mini shock waves, which will break it down into small fragments so that they may be passed naturally. ESWL is an outpatient procedure which may require some pain relief but does not require any type of anaesthetic (numbing or being put to sleep). It is carried out at Stepping Hill Hospital, Stockport. What Are The Benefits? Kidney stones can cause symptoms such as pain, infection and/or obstruction of the drainage of urine from the kidney to the bladder. This treatment is used to remove the stone and therefore relieve these symptoms. What Are The Alternatives? Open surgery (cut on your abdomen or on the side of the affected kidney). Percutaneous nephrolithotomy (a small incision on the side of the abdomen of the affected kidney), which enables a special needle to travel through the skin to break up the stone. Do nothing, although this may affect your health. Are there any Special Instructions to follow before my appointment? If you take medication to thin your blood (anti-coagulants) please seek advice from the nursing staff at Stepping Hill Urology Department before your appointment between 8.15am and 4.45pm Monday to Friday (not including bank holidays) telephone number 0161 419 5697, as some of these drugs may need to be stopped prior to this procedure. Below is a list of common anti-coagulation tablets: Warfarin or Sofarin Clopidogrel or Plavix Clexane or Enoxaparin Dipyridimole or (persantin or Asasantin) Ardeparin or Indeparin Rivaroxaban Danaparoid 6 Lithotripsy 2 of 7
Aspirin Fondaparinux or Arixtra Dabigatran Etexalate Acenocoumarol or Sinthrome Phenindione Abciximab Eptifibatide Tirofiban Ticlopidine Please bring your most recent prescription from the GP along with you to your appointment as this will allow us to see the medication you are taking. Please telephone the department to inform the nursing staff if you have a pacemaker. It is important to contact the department to let the staff know if you are or think you may be pregnant. As x-ray equipment is used throughout the treatment, lithotripsy cannot be performed if you are pregnant. On The Day of the Procedure If your treatment is in the morning, you should have a light breakfast (such as toast or cereal). If your treatment is in the afternoon, you should have a light lunch (such as soup or a sandwich). You should drink your normal amount of fluids but ensure that these are clear fluids (e.g. cordial mixed with water) for the 2-4 hours before the procedure. What Happens To Me When I Arrive At The Department? You will be greeted by the nursing staff looking after you, who will prepare you for the procedure. The treatment will be explained to you fully and you will be asked to sign a consent form. Any medication required prior to the procedure will then be given to you. If you have problems with high blood pressure, are not feeling well or think you may have a temperature on the day of your treatment, please tell the nursing staff. During your time at the clinic, please feel free to ask the nursing staff any questions you may have about the treatment or inform them of any worries or anxieties you may have. It is important that during the treatment, you are as relaxed as possible. What Happens During The Treatment? When you have been fully prepared, you will be escorted into the room where the lithotripsy equipment has been set up and the technicians will ask you to lie on the treatment table, usually face down. As the kidneys are situated towards the back of the 6 Lithotripsy 3 of 7
body, this helps to treat the stone more effectively. However, you may be asked to lie on your back if the stone is in one or both of your ureters (the tubes from the kidneys which come down towards the front of the body into the bladder). Once you are in position on the treatment table, you will be asked not to move and to keep your breathing as shallow as possible. This helps to locate the stone using the x-ray or ultrasound equipment. When that is done we will line-up the Lithotripter (the machine that delivers the shockwaves) to your back/front. The x-ray machine is linked, via sensors, to the Lithotripter so that we get a precise image of your stone to be able to treat it accurately and effectively. Movement will hinder the effectiveness of shockwave delivery, which is why it is important that you control your breathing and do not move. Ultrasound jelly is then applied to the area where the lithotripter treatment head (a cushion with water inside) will go. The jelly helps to create a good seal between your skin and the cushion, and as it is water based, it is easily washed off after the procedure. When the stone is in the correct target area, treatment can begin. Throughout the treatment you will hear a clicking noise and may feeling something like a flicking on the area being treated. Some people have described this as a small electric shock and it may feel uncomfortable but should be bearable. The power/intensity of the machine may be slowly increased throughout the treatment, to ensure a good enough level of power to break or weaken the stones. If it gets too painful, let the nursing staff or technicians know as the level can be reduced at any time. The stone will be monitored via the x-ray equipment throughout the procedure, to make sure that it has not moved. It may be necessary to move the table at times, to ensure accurate treatment of the stone. The breaking down process may take slightly longer with hard stones and may need more than one treatment. How Long Does The Treatment Last For? The treatment will usually last for about twenty to sixty minutes. Very occasionally a mild sedative may be offered if you are particularly worried or anxious, as it is very important that you stay extremely still throughout the treatment. What Happens After The Procedure? You will usually only need to stay about an hour following the treatment, to ensure that you are comfortable and not experiencing any problems. The nursing staff will ensure you pass urine before you leave the department. Are There Any Risks Involved? Blood in the urine - this is quite normal and resolved by drinking plenty of fluids. A bruise on your back - this is caused by the head of the equipment being placed on the skin. 6 Lithotripsy 4 of 7
Pain in kidney - the passage of small stone fragments through the urinary system may cause pain. If you experience any discomfort you should take the same painkillers as you would for a headache. Infection - occasionally infection occurs and may require antibiotic treatment. You should see your GP as soon as possible if you experience a fever or feel generally unwell. Difficulty or inability to pass urine you should see your GP as soon as possible if this occurs. Obstruction caused by stone fragments rarely stone fragments can get stuck in the ureter (tube between the kidney and bladder) which occasionally requires further surgery. Repeat treatment the shockwaves will weaken the stone initially and may not break it completely. You may therefore need more than one session of lithotripsy to get rid of the stone completely. Further surgery occasionally more invasive procedures or operations are required if lithotripsy has not been successful in completely treating the stone. Discharge Arrangements It is necessary to arrange for a responsible adult to collect you from hospital and transport you home following the treatment, as medication may be given which can make you feel a little sleepy. It is extremely important that you drink 2 to 3 litres of fluid for up to 7 days after the treatment. This will help flush out the kidneys and aid the breaking down of the stone process. If you do not drink, the treatment will not work. You will receive an appointment to attend the stone clinic at your local urology department, approximately two weeks after the treatment where an x-ray may be taken before you see the doctor. Day To Day Living You can resume your normal activities the day after your treatment. Stay as active as you can after the treatment. Swimming and walking are recommended, as they may help you to pass the small stone fragments. The passage of stone fragments may cause pain and/or a temperature. You should take simple painkillers (for example paracetamol) if you experience any discomfort. 6 Lithotripsy 5 of 7
If there is a Problem? If you have any problems or concerns following your treatment, please contact your GP immediately. Other Useful Contacts or Information If you have any questions you want to ask, you can use this space below to make notes to remind you. Source In compiling this information leaflet, a number of recognised professional bodies have been used, including the British Association of Urological Surgeons. Accredited good practice guidelines have been used. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Health Information Centre on 0161 922 5332 If you would like any further information please telephone the Urology Nurse Specialists at your local Urology Department on: Stepping Hill 0161 419 5695 Tameside 0161 922 6696/6698 Macclesfield 01625 661517 6 Lithotripsy 6 of 7
Author: Urology Department Division/Department: Elective Services Date Created: June 2003 Version: Version 1.5 6 Lithotripsy 7 of 7