Name of the Procedure:

Anesthesia for Lithotripsy, Extracorporeal Shock Wave Without Water Bath

Summary

This procedure entails administering anesthesia to a patient undergoing Extracorporeal Shock Wave Lithotripsy (ESWL), which is a non-invasive treatment used to break down kidney stones using shock waves. Unlike traditional ESWL, this method does not utilize a water bath.

Purpose

Extracorporeal Shock Wave Lithotripsy is used to treat kidney stones that cause pain, interfere with kidney function, or obstruct the urinary tract. The goal is to break the stones into smaller pieces that can pass through the urinary system easily, relieving the patient's symptoms and preventing complications.

Indications

• Persistent kidney stones that do not pass on their own
• Chronic pain associated with kidney stones
• Obstruction of the urinary tract
• Infection or risk of infection due to kidney stones
• Kidney stones that affect kidney function

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies (e.g., X-rays, CT scans) are often required to locate the stones and plan the treatment.
• Patients should inform their healthcare provider of any medications they are taking, as some may need to be adjusted.

Procedure Description

1. The patient is positioned comfortably on a treatment table.
2. Anesthesia is administered, usually through an IV line, to ensure the patient is pain-free and comfortable.
3. The lithotripsy machine generates shock waves targeted at the kidney stones, breaking them into smaller fragments.
4. The patient is monitored throughout the treatment for any adverse reactions.
5. After the stones are fragmented, the pieces pass out of the body through the urine over the following days to weeks.

Duration

The procedure typically takes about 45 to 60 minutes.

Setting

Extracorporeal Shock Wave Lithotripsy without a water bath is usually performed in a hospital's radiology department or an outpatient surgical center.

Personnel

• Anesthesiologist or nurse anesthetist
• Urologist
• Radiologist or technician operating the lithotripsy equipment
• Nurses and other support staff

Risks and Complications

• Bruising or discomfort at the treatment site
• Blood in the urine
• Urinary tract infection
• Failure to completely fragment the kidney stones, necessitating additional treatments
• Rarely, more serious complications like kidney damage or persistent pain

Benefits

• Non-invasive and does not require an incision
• Effective in breaking kidney stones into smaller, passable fragments
• Less recovery time compared to surgical alternatives
• Minimal hospitalization

Recovery

• Patients can usually go home the same day after the anesthesia wears off.
• Pain medication may be prescribed for discomfort as the stone fragments pass.
• Increased fluid intake is recommended to help flush out the stone fragments.
• Follow-up imaging may be required to ensure all fragments have passed.
• Patients may need to avoid strenuous activities for a few days.

Alternatives

• Ureteroscopy: A procedure where a small scope is used to remove or break up stones.
• Percutaneous nephrolithotomy: A surgical procedure to remove large kidney stones via a small incision in the back.
• Conservative management: Allowing smaller stones to pass naturally with pain management and increased fluid intake.

Patient Experience

Patients might initially feel some discomfort or mild pain, especially when the stone fragments begin to pass. Pain management and comfort measures such as warm baths and the use of prescribed pain medication help alleviate these symptoms. Follow-up care is essential to monitor for complications and ensure complete stone removal.