Now that you know what is lithotripsy, you must find out that the lithotripsy treatment lasts for 30 minutes per session, up to three sessions. There must pass seven days between shockwave lithotripsy sessions.
Preparing patient for ESWL lithotripsy involves a set of laboratory exploration strictly necessary: blood analysis, coagulation tests, renal function, potasium level, EKG, urine analysis, quantitative urine sediment, urine culture, ultrasound, intravenous urography, pregnancy test for women. Results of these analysis must be all recent.
After the kidney stone lithotripsy, the patient remains at rest for two hours. He will be trained how to recover any stone fragments that he evacuates, he will receive indications of treatment required to facilitate removal of calculus fragments and he will be thought how to recognize any complications.
A tube may be placed through the bladder or back into the kidney. This tube will drain urine from the kidney until all the small pieces of stone pass out of the body. The tube may be put in place before or after the extracorporeal lithotripsy treatment.
After 10 to 14 days a medical exam is programmed, involving: sanguine analysis, urinalysis and urine culture with sediment quantity and simple radiography. There will be assessed the chemical type of stones, with the evaluation of possible predisposing diseases. According to the results there will be applied background therapy.
The antiplatelet therapy (aspirin, diclopidin) or anticoagulants should be stopped 5-7 days before ESWL.
Patient will be explained the extracorporeal shockwave lithotripsy procedure, benefits, risks and chances of its success. Patient and physician will sign the consent form, information that would be attached to an observation sheet. The previous day the patient must keep a diet and have easy chair, and the day that is scheduled for ESWL should not eat and take their usual medication (for chronic conditions) with small amount of water.
The list of necessary investigations
- A. Lab analysis
- a. blood : urea, creatinine, blood count, blood sugar, TQ + AP + INR, APTT, fibrinogen.
- b. urine : uroanalysis and uroculture.If the urine is infected the ESWL procedure cannot be permitted. In this case the patient goes to the doctor, urologist or nephrologist, makes the necessary treatment and after 2 weeks repeats the urine analysis. If the results are sterile patient qualifies for ESWL lithotripsy.
- B. Paraclinic investigations
- a. renal ultrasound
- b. EKG
- c. Urography
The first session of ESWL lithotripsy
The session of shockwave lithotripsy lasts about 30 minutes. Depending on the case your doctor may recommend and perform other investigations or medication.
The second and third session
After 7 days since the first lithotripsy procedure the patient returns to a medical control when the doctor can find:
- - the stone broke as a result of the first session of ESWL lithotripsy and no longer continues treatment.
- - the stone is partially fragmented and therefore is necessary to do a second session of ESWL
- - the stone has not undergone any change and the doctor will use a higher intensity for the next meeting.
Before each session of ESWL the patient signs a consent form that agrees on the treatment. The waiting time between sessions of ESWL is 7 days.
If after 4 sessions the stone has not undergone any change no longer continues treatment and surgical intervention is recommended in this case.
After each session of ESWL the patient receives a written statement / letter stating that medical treatment was applied + advice needed about both diet and medication which is established according to age, medical history etc.
Monitoring and evaluation
After one month since sessions 3 or 4 (or the session from which the stone was broken) the patient returns to the doctor who performed ESWL for a control and an ultrasound and also, eventually, urine analysis.
Important info about lithotripsy treatment
If the foreign patient has a Cook probe he can leave the country in 24 hours after the completion of ESWL.
Foreign patients will come with the Cook probe mounted (especially for stones larger than 1.5 cm) – currently the Gral Clinic can not mount probes because it is necessary an operating room.
ESWL renal lithotripsy is not suitable for pregnant women.