What kind of stones are suitable for extracorporeal lithotripsy treatment?
Kidney stones: single stones in the renal pelvis or calyces with a diameter of less than or equal to 2 cm or multiple stones with a total volume equivalent to it and a moderate or less fluid accumulation in the kidney are the best indications for extracorporeal shock wave lithotripsy. Stones with a diameter of 2-3 cm can still be lithotripsed with an extracorporeal shock wave lithotripter, but a preoperative ureteral catheter or stent is required. Surgery is preferred for patients with moderate effusion or more, regardless of the size of the stone. (The size of the stone should be measured by X-ray or CT)
Ureteral stones: middle and upper ureteral stones less than 1,5 cm in length are the best indications for in situ extracorporeal shock wave lithotripsy. Patients with stones that have been in place for longer than 6 months, or with stones of large size or dense structure, or with moderate or above-grade renal effusion, or with stones in the lower segment, are preferred for surgery.
For bladder stones, transurethral intracorporeal lithotripsy is preferred. Stones less than or equal to 2 cm in diameter can be lithotripped by extracorporeal shock wave lithotripter. For patients with urethral stricture or prostatic hyperplasia combined with obstruction, surgery is preferred because it is difficult to discharge the stone even after extracorporeal shock wave lithotripsy.
4, urethral stones: the first choice can be directly removed or in situ pneumatic ballistic lithotripsy, but also can be pushed back to the bladder and then extracorporeal shock wave lithotripsy machine lithotripsy.
In what cases is extracorporeal shock wave lithotripsy not suitable for treatment?
1.Pregnancy
2. Abnormal blood clotting mechanism
3.Acute urinary tract infection (especially in patients with blood and urine routine suggesting inflammation and stomach cold and fever), stone obstruction and pus accumulation in the kidney, chronic urinary tract infection (requiring sensitive antibiotics for more than 3 days)
4.Urinary tract obstruction distal to the stone, non-obstructive renal insufficiency, bilateral upper urinary tract stone obstruction and renal insufficiency
5.Severe cardiovascular disease (uncontrolled hypertension, arrhythmia), severe diabetes mellitus, patients with cardiac pacemakers
6.Infectious disease active period
7.Complex stones
8.Stone obstruction and moderate to severe renal effusion
If I choose extracorporeal lithotripsy, what preparations should I do?
(A) Routine examination before lithotripsy
1.Must check: routine blood and CRP, routine urine, renal function, electrolytes, blood sugar, coagulation, electrocardiogram, urological ultrasound or urogram (DR), and CT if necessary for negative stones.
2. Other tests are selected according to the specific situation.
(1) Some patients may require intravenous urography (IVP)
(2) Patients with liver disease require liver function tests, other patients may also undergo this test
(3) Chest X-ray is required for those with lung disease
(4) Patients with urinary tract infections are recommended to have mid-stage urine bacterial culture and drug sensitivity especially for patients with moderate to severe urinary tract infections and recurrent urinary tract infections with stones.
(5) Patients with hypertension: blood pressure control is required before lithotripsy
(6) If using anticoagulants, stop using them for at least 2 weeks before treatment and check coagulation function to normal before extracorporeal shock wave lithotripsy
(7) Patients with diabetes mellitus: blood glucose should be controlled before extracorporeal shock wave lithotripsy is performed.
(8) Patients requiring anesthesia (mostly in children) should be prepared according to the requirements of anesthesia
(9) For lower and middle ureteral stones, extracorporeal shock wave lithotripsy can be performed at 8:00 pm the day before and fasting in the morning of the treatment day if available. If lithotripsy is performed in the afternoon, fasting at noon on the same day. This may make it easier to detect and locate the stone.
Are there any other things that need to be noted?
(1) Patients with poor kidney function: extracorporeal shock wave lithotripsy is not recommended.
(2) Patients with obese stones have relatively poorer lithotripsy results.
(3) Sign the informed consent form for extracorporeal shock wave lithotripsy before lithotripsy
(4) For large stones and infected stones, antibiotics should be used three days before lithotripsy.
(5) Urinary tract infection should be controlled with antibacterial drugs before lithotripsy.
(6) Drinking 500ml of water 40 minutes before treatment is useful to protect the kidneys.
Special preparation
Ureteral stents or catheters should be placed before lithotripsy in patients with the following stones.
(1) Huge stones over 2 cm in diameter or those whose stones are difficult to be lithotripsed at one time;
(2) Isolated kidney;
(3) Ureteral stones that are difficult to fragment.
What else should be done after lithotripsy to make the stone come out as soon as possible?
1.Regular precautions
(1)Drinking water and rehydration: it is recommended to drink more than 2500ml of water per day.
(2) rest: generally 2-3 days after lithotripsy can gradually increase the amount of activity, according to the stone site to take different positions, such as head low foot high position, percussion kidney area, jumping movement of multi-directional activities; but kidney stone patients within a week after lithotripsy pay attention to rest (especially complications of perirenal hematoma, back pain for a long time and serious hematuria), do not carry out intense exercise.
(3) Lithotripsy position: different positions can be used for different parts of the stone to assist in lithotripsy, and special positions can not be used for renal pelvis, upper and middle renal calyces, ureter, bladder and posterior urethra stones. Stones in the lower renal calyces should be discharged in a head-low, foot-high position for better results. (Inverted three-dimensional position)
(4) The number of treatments and treatment interval of extracorporeal shock wave lithotripsy machine: The number of treatments of extracorporeal shock wave lithotripsy for kidney stones is generally recommended to be no more than 5 times, and the number of treatments of extracorporeal shock wave lithotripsy for ureteral stones is generally recommended to be no more than 3 times, and the treatment interval is currently 7-14 days.
Do I still need to take medication after lithotripsy?
(1) Chinese herbal medicine, Chinese herbal medicine and western medicine (including progesterone, terazosin capsules, cardiac painkiller, etc.) can be used to promote the discharge of stones.
(2) Patients with infected stones or large stones can consider using antibacterial drugs for 3 days after lithotripsy
(3) For patients with urinary tract infection, antibacterial medication is recommended until the urinary tract infection is controlled.
Is extracorporeal lithotripsy dangerous?
(1) hematuria: no need to deal with mild hematuria, if it is obvious, give more rest and less activity.
(2) Fever: give symptomatic and antibacterial treatment
(3) Stone: usually require hospitalization for transureteral ureteroscopic lithotomy
(4) Perirenal hematoma: treat as renal contusion
(5) Nausea and vomiting: after lithotripsy, a few patients may experience nausea and vomiting, loss of appetite, etc. This is due to the symptoms of the process of lithotripsy debris discharge, and can be treated with symptomatic treatment such as gastric rejuvenation and vitamin B6.
When should I have a review? What should be checked?
(1) Generally 12-15 days after lithotripsy to check the lithotripsy discharge.
(2) The content of the review: the patient’s stone discharge to understand the situation, the presence of complications, review of urinary tract plain film, urinary ultrasound, blood routine, urine routine, kidney function, other review according to the systemic disease situation.
(3) Long-term review: review once every six months or so.