Extra Corporeal Shock Wave Lithotripsy (ESWL)

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What is Lithotripsy?
Extracorporeal Shock Wave Lithotripsy (ESWL) is a modern, non-surgical way of treating kidney stones, without General Anaesthetic. The treatment lasts approximately 30 minutes and uses ultrasound equipment and x-ray screening to provide a precise image of your stone. The lithotripter generates mini shock waves that weaken and break the stone. This may happen during the treatment but is more likely to happen in the following days or weeks.

Are there any special instructions before my appointment?
If your treatment is in the morning, have a light breakfast (such as toast or cereal). If your treatment is in the afternoon, have a light lunch (such as soup or a sandwich). You should drink your normal amount of daily fluids.

What will happen when I come into hospital?
Please attend the appointment with a comfortable full bladder as you will be given a specimen pot and asked for a urine sample. This is to check that you do not have a urine infection. If you do, this may mean we cannot go ahead with the lithotripsy until this has been treated. On your arrival you will be asked some questions about your general health. The procedure will be explained and you will sign a consent form. You may have to wait a short while for your treatment as we treat several people on the same day. Female patients need to let staff know if they are or maybe pregnant as lithotripsy cannot be performed on pregnant women. Please tell the nursing staff if you have a temperature or feel unwell on the day of your treatment, as it may not be suitable for you to have treatment that day. It is important to let the nursing staff know if you have a pacemaker or are taking anti-coagulants such as Warfarin or Aspirin. The nursing staff will be happy to answer any
questions or concerns about your treatment and our  aim is to make your treatment process as comfortable as possible.

What will happen during the treatment?
The treatment is generally well tolerated but may cause some discomfort. You will be taken to a specially equipped treatment room and the technician will explain the procedure. You will usually lie on your back on the table for your treatment but may be required to change position depending on the position of your stone(s). The technician will put some ultrasound gel on the area of skin in contact with the lithotripsy machine. The gel is water based and will wash off easily. Once you are correctly positioned on the table you will be asked to lie as still as possible and to keep your
breathing as shallow as possible. The stone will be located using the x-ray or ultrasound machine. Movement can alter the effectiveness of the shock wave delivery.

The technician will tell you when treatment is about to commence and you will hear a repetitive clicking sound from the machine and feel a ‘flicking’ sensation against your skin. The power and intensity of the machine will be increased as the treatment progresses, if it becomes too uncomfortable you should tell the technician who will adjust the power level. It is important to reach a good level of power to break or weaken the stone. During the treatment the table may need to be moved to keep the shock waves accurate, you will be informed of your treatment’s progress. When your treatment has finished you will be able to go home. You should rest for the rest of the day but can resume normal activities the next day. It is extremely important to drink plenty of fluids for up
to seven days after your treatment, about 2-3 litres daily, to help flush the stones from your urinary tract.

What complications should I be prepared for?
Stay as active as you can after your treatment, swimming and walking are ideal. You may see some blood in your urine after treatment, this is quite normal, increase your fluid intake. You may also notice a bruise on your back where the treatment head was placed. You may experience some pain and should take your usual analgesia. Occasionally you may experience some side effects from the treatment. If you have any of the following you should seek medical advice:

• A burning sensation when you pass urine.
• A temperature and flu like symptoms.
• Difficulty or inability to pass urine.
• If you have severe loin pain or in the surrounding area.

You should avoid aspirin as this may increase the amount of blood in your urine. You must tell us if you are taking Warfarin, if you are pregnant or have been diagnosed with a bleeding disorder as you may not be suitable for ESWL.

Follow up
You will receive a follow up appointment 4-6 weeks after your treatment. An x-ray will be taken and the doctor will decide if you need more treatments. You can have a maximum of three. If you have any problems or concerns you can contact your GP service, Or you can attend the walk in centre at Milton Keynes Hospital.