Lithotripsy

Lithotripsy Unit At Evercare Hospital Dhaka

Extracorporeal shock wave lithotripsy (ESWL) is a technique for treating stones in the kidney and ureter without surgery; instead, the procedure involves passing high energy shock waves through the body which breaks the stones into pieces as small as grains of sand. Because of their small size, these pieces can now pass from the body through urine.

Evercare Lithotripsy Unit, under the Department of Urology, is a fully equipped day-care procedure unit located in level-5 (OPD). We have the latest lithotripsy machine “Lithoskop” and other facilitates for the effective treatment of your kidney and ureter stones. Our skilled medical and nursing staff performs the lithotripsy procedure, and closely observes and monitors the patient. The unit and its patients are directly supervised and followed-up by our highly experienced Urology Consultant. Lithotripsy is usually done on an out-patient basis and after the procedure patients can rest for 1 or 2 hours in the day-care, located within the unit. However, in some cases patients are hospitalized for a day or two.

CONSULTATION & APPOINTMENT

Evercare Urology Department provides consultation services for patients seeking lithotripsy or patients who already underwent lithotripsy. Our highly qualified and experienced Urology Consultant sees patients at level-2 (OPD). After diagnosing your condition, we discuss available treatment options and recommend the most effective treatment.

Consultation and Appointment in the Department of Urology: CLICK HERE

Make Appointment for Lithotripsy: Although it is best to consult our urologist first, you can also make direct appointments to avail lithotripsy services. To make an appointment for lithotripsy, please call us at the following number: 02-8431661 Ext. 5102.

BEFORE THE PROCEDURE

Prior to lithotripsy procedure, a complete physical examination of the patient is performed, followed by Intravenous Pyelogram (IVP) test and x-ray to determine the number, location, and size of the stones.

Blood tests maybe performed to determine if any potential bleeding problems exist. For women of childbearing age, a pregnancy test may be done to make sure they are not pregnant. Older persons can have an EKG test to make sure that no potential heart problems exist. Some individuals may have a stent placed prior to the lithotripsy procedure. A stent is a plastic tube placed in the ureter that allows the passage of gravel and urine after the ESWL procedure is completed.

Regarding medication specifications, you can take most of your medications as usual. Bring a list of current medications to your doctor before lithotripsy. Lithotripsy cannot be performed if you have taken warfarin, aspirin, clopid, etc in the week prior to your procedure date.

DURING THE PROCEDURE

During the procedure, you will be positioned comfortably on the lithotripsy machine, after which the stones will be targeted with x-rays or ultrasound. A water-filled cushion will be placed against your body. It is important to lie still during your treatment so that the shock waves can be targeted accurately on the stone. About 2-3 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes. In general, some type of pain killers or sedatives are used to help the patient remain still and to reduce any discomfort.

RECOVERY AFTER THE PROCEDURE

After the procedure is complete, the patient is rested for 1 or 2 hours in the unit’s day-care and can move freely within a few hours. Many people can fully resume daily activities within one to two days. Special diets are not required, but drinking plenty of water helps the stone fragments pass. Some pain may occur when the fragments pass, which begins soon after treatment and may last for up to four to eight weeks. Oral pain medication and drinking lots of water will help relieve these symptoms.

ADVANTAGES & DISADVANTAGES

The main advantage of this treatment is that many patients may be treated for kidney or ureter stones without surgery. As a result, complications, hospital stays, costs and recovery time are reduced. Unfortunately, not all types of stones can be treated this way. In addition, stone fragments are occasionally left in the urinary tract and additional session/ treatments are needed.

Complications/side effects

Most patients have some blood in the urine for a few days. Heavy bleeding is rare after lithotripsy, but external bruising in or around the treated kidney is occasionally seen. The shattered stone fragments may cause discomfort as they pass through the urinary tract. Fever chills or shakes after the procedure may indicate infection. Medical attention should be sought promptly so that treatment can be provided if necessary. Occasionally, blockage of a ureter with stone fragments after lithotripsy will require additional treatment including surgery (endoscopic procedure).

IS LITHOTRIPSY RIGHT FOR ME?

The size, number, location and composition of the stones are factors that must be taken into account when exploring treatment options. Also, the stones must be clearly viewed by the x-ray monitor so the shock waves can be targeted accurately. If anatomical abnormalities prevent this, other methods of stone removal may have to be considered. Through examination, x-ray and other tests, the doctor can decide whether this is the best treatment for the patients. In some cases, extracorporeal shock wave lithotripsy may be combined with other forms of treatment.
Lithotripsy may not be possible or effective on patients with the following conditions:

• Very large or hard stones
• Pregnancy
• Very overweight
• Bleeding disorders
• On blood thinner drugs

SUCCESS WITH LITHOTRIPSY

Prospective patients are found to be free of stones within three months of treatment. The highest success rates seem to be in those patients with mobile stones that are located in the upper portions of the urinary tract (kidney and upper ureter). After treatment, some patients may still have stone fragments that are too large to be passed. These can be treated again if symptoms persist.

COMPLEMENTARY PROCEDURES

About 90 percent of stones (less than 5 mm in size) which are treated by lithotripsy pass through the urinary system without treatment. In other cases, percutaneous stone removal (PCNL) and ureteroscopic stone removal (URS) can be followed.

For large stones (more than 2 cm) or stones in location that do not allow effective lithotripsy, PCNL may be used. A tube is inserted through a small incision in the back, into the kidney and the stone is removed through this tube.

URS is used for stones found in the lower part of the urinary tract. The doctor may pass an ureteroscope (a hollow tube-like device) up into the bladder and ureter to grasp and withdraw stone.

PREVENTING FURTHER STONES

People who have had more than one kidney stone are likely to form another. To determine the possible cause of stones, the patient may be asked to collect a 24-hour urine sample, few blood test & stone analysis. Once the cause is found, the doctor may recommend drinking more liquids, dietary changes and medication.