Extracorporeal shock wave lithotripsy
Urinary stones include kidney stones, ureteral stones, bladder stones and urethral stones. They can cause severe colic, hematuria, nausea, vomiting, frequent urination, urinary urgency, high fever and even anuria. It causes great pain to the patient. In severe cases, uremia may even occur. Extracorporeal shock wave lithotripsy (ESWL) is the preferred method for the treatment of urinary stones.
Indications
Patients with stones ≤2.5cm≥0.6cm in the kidney, ureter, bladder and urethra that cannot be expelled from the body on their own are suitable for lithotripsy treatment, except for severe comorbidities.
Contraindications
Patients with bleeding disorders and urinary tract obstruction distal to the stone are absolute contraindications to lithotripsy. Many patients can undergo extracorporeal shock wave lithotripsy after urological examination under the guidance of a specialist.
1. Pregnant women are generally not suitable for lithotripsy to avoid adverse effects of shock waves and radiation on the fetus, and may choose to undergo lithotripsy after delivery.
2. Patients with diabetes mellitus, whose condition is not controlled, are not suitable for lithotripsy to avoid outbreak of infection after lithotripsy.
3, Infected patients, lithotripsy may aggravate infection, cause bacteraemia, toxemia, infection toxic shock.
4.Patients with vital organ insufficiency, choose lithotripsy with caution in the presence of further therapeutic measures.
5, overly obese patients may not be able to lithotripsy because of positioning difficulties.
6. Patients with acute colic are not easy to be lithotripsy blindly, and the lithotripsy effect can be improved after treatment and stabilization.
Preparation before lithotripsy
1, routine examination: routine blood, urine, clotting time, platelet count, liver and kidney function, electrocardiogram, etc.
2.Urological system: This is an essential preparation for lithotripsy treatment, which must be exhaustive, avoiding hasty lithotripsy to avoid accidents.
(1) Ultrasound: It is simple, convenient and timely, and can make diagnosis quickly. Due to the effect of intestinal gas on the middle ureteral stones are easily missed.
(2) Abdominal plain film: abdominal plain film examination can provide a comprehensive understanding of the location, size, number and density of stones. In some patients, due to low density of stones, abdominal radiographs do not show up and other tests are needed.
(3) Urography: Intravenous urography can accurately understand the morphology and function of the urinary system, which is important for determining the effect of stone fragmentation. Retrograde urography is a method to grasp the urinary tract obstruction without the kidney being visualized.
(4) CT examination: A method that can clearly show the morphology, contour, and the ratio of the urinary system. It is also able to identify many diseases after intensification.
(5) Nephrographic examination: Nephrographic examination to understand the secretory function and excretory function of the divided kidney.
3.Pre-lithotripsy preparation: It is better to take laxative to remove intestinal gas and fecal matter one day before lithotripsy, which not only facilitates stone localization, but also reduces the energy loss of shock wave by intestinal gas and significantly improves the lithotripsy effect.
Precautions after lithotripsy
(1) Rest: Patients with large kidney stones should rest in bed within three days after lithotripsy, with as little bed activity as possible, and adopt the patient’s side to slow down the discharge of lithotripsy particles as much as possible and reduce the possibility of forming stone streets.
(2) Activity: Encourage patients to move more after lithotripsy to facilitate the discharge of stones.
(3) Drinking water and rehydration: flushing of urine is the best way to help stone removal. Drinking more water can increase the volume of urine to promote stone removal.
(4) Lithotripsy positions: Different positions can be used for different parts of the stone to assist in stone removal, and special positions may not be used for renal pelvis, upper and middle renal calyces, ureter, bladder and posterior urethra stones. For stones in the lower renal calyces, a head-low, foot-high position is recommended for better results.
(5) Lithotripsy: Lithotripsy is more effective when combined with Chinese and Western medication.
(6) If local discomfort, fever or colic occurs after lithotripsy, patients should seek medical consultation and treatment in time.
(7) After lithotripsy, patients should pay attention to the discharge of stones in urine and collect stone fragments to check the stone composition, which is important to prevent stone recurrence.
(8) Timing of review: Stable condition after lithotripsy is usually reviewed after 2 weeks, and further treatment is guided according to the patient’s stone discharge.