50590 Lithotripsy, extracorporeal shock wave

Name of the Procedure:

Extracorporeal Shock Wave Lithotripsy (ESWL)

Summary

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive procedure that uses shock waves to break down kidney stones into smaller fragments, which can then be naturally passed out of the body through urine.

Purpose

ESWL is used to treat kidney stones that are too large to pass on their own. The procedure aims to break the stones into smaller pieces, making them easier to expel and relieving any associated pain or urinary obstruction.

Indications

• Kidney stones larger than 5-10 mm.
• Severe pain from kidney stones.
• Stones causing obstruction or infection.
• Patients who cannot undergo more invasive procedures due to health reasons.

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjustments or discontinuation of certain medications as advised by your doctor.
• Pre-procedure imaging tests, like X-rays or CT scans, to locate the stones.

Procedure Description

1. The patient is positioned on a water-filled cushion.
2. Anesthesia or sedation may be administered to ensure comfort.
3. Shock waves are generated outside the body and targeted precisely at the kidney stones using imaging guidance.
4. These shock waves travel through the skin and tissues to break the stones into smaller pieces.
5. The patient will be monitored throughout the procedure by a healthcare team.

Duration

The procedure typically takes about 45 minutes to 1 hour.

Setting

ESWL is performed in an outpatient clinic, hospital, or specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Nurses
• Anesthesiologist (if sedation or anesthesia is used)
• Radiology technician

Risks and Complications

• Pain or discomfort during and after the procedure.
• Blood in the urine.
• Bruising or bleeding around the kidneys.
• Infection.
• Stone fragments causing blockage as they pass.

Benefits

• Non-invasive treatment option.
• Effective in breaking down most types of kidney stones.
• Quick recovery time compared to surgical alternatives.
• Typically, stones are fully passed within a few weeks.

Recovery

• Mild pain and discomfort are normal and can be managed with pain medication.
• Increase fluid intake to help flush out stone fragments.
• Follow-up imaging tests to ensure all fragments have passed.
• Patients can usually resume normal activities within a few days.

Alternatives

• Ureteroscopy: Involves using a small scope to remove stones from the urinary tract.
• Percutaneous Nephrolithotomy (PCNL): A surgical procedure for larger stones.
• Medications to dissolve certain types of stones.
• Each alternative has its own set of risks, benefits, and recovery times.

Patient Experience

• The patient may feel some tapping or slight discomfort during the shock wave delivery.
• Pain management will be provided for any post-procedure discomfort.
• It's essential to follow all post-procedure instructions to ensure a smooth recovery.