Contents
The method of extracorporeal shock wave nephrolithotripsy, or ESWL, is considered a non-surgical method for removing stones from the bladder. Its name comes from the Greek words lithos and tribo, which means “stone” and “crush” in translation. What is this procedure? How to prepare for it and what to expect? All this can be found by reading the following article.
What is this procedure
In another way, such a procedure is called: remote nephrolithotripsy, shock wave remote lithotripsy, ESWL, ESWL of kidney and ureter stones under ultrasound guidance.
With this procedure, the crushing of stones in the bladder is carried out by exposing them to ultrasonic waves of directional action. Wave impulses easily penetrate the skin and nearby tissues, directing all their energy to a specific focus point, which is a stone. As a result, a pressure of 160 kPa is exerted on it, which leads to the gradual destruction of stones.
The result of this procedure is the fragmentation of large stones into smaller fragments, which are subsequently freely excreted naturally through the urinary tract.
Such treatment is carried out with the help of special devices – lithotripters, which create a shock wave. Such a wave is formed in several ways: electromagnetic, electro-hydraulic or piezoelectric.
The focus of this device is focused using an ultrasound machine or X-ray radiation. Initially, the energy of the wave is quite small, and therefore does not destroy the tissues located between the stone itself and the source of wave radiation.
This procedure is much more effective than surgery, while its price is also much lower. For the first time, such a non-surgical procedure for crushing stones was carried out in 1983 in Germany, and in the Soviet Union it began to be used only since 1987.
Symptoms of the onset of the disease and indications for lithotripsy
Stones that accumulate in the kidneys and ureters are different: oxalate and phosphate, cystine, urate and xatin. Kidney disease can be identified by some visual signs, but for an accurate diagnosis, you need to visit your doctor.
Symptoms that indicate kidney problems can be characterized as follows:
- pain in the lumbar region of a regular nature;
- bags under the eyes, swelling of the upper and lower extremities;
- fever, chills, headache;
- pain when urinating, frequent urination;
- clear or cloudy urine;
- increased pallor of the skin, sometimes with a yellowish tint;
- problems with nails and hair.
Indications for treating a patient using the method of remote nephrolithotripsy are stones with a diameter of 0,5 to two centimeters in the kidneys, ureters or urinary tract, renal colic caused by stone formation. The procedure is also indicated for obligatory free outflow of urine below the location of stones and free visualization of stones in the kidneys and urinary canals.
Contraindications to the procedure
Contraindications to such treatment are:
- the growth of the patient exceeding two meters;
- obesity in advanced forms, with a weight of more than one hundred and thirty kilograms;
- pathology of the musculoskeletal system;
- arrhythmia and other cardiac disorders;
- pregnancy or menstruation;
- obstruction of the free outflow of urine below the located stone;
- acute inflammatory processes of the genitourinary system: cystitis, urethritis, pyelonephritis;
- decompensation of other concomitant diseases, infectious and inflammatory processes in the body;
- kidney failure or kidney tumor.
Preparation and procedure
Before the direct carrying out of this procedure, the doctor without fail tells the patient about exactly how it is carried out and what it is. Also, the specialist directs the patient for additional diagnostics, which includes:
- general urinalysis and clinical blood analysis;
- chest x-ray;
- analysis for blood group and Rh factor;
- electrocardiogram;
- blood chemistry;
- blood test for RW, HIV, viral hepatitis;
- coagulogram.
In some cases, especially with a pronounced inflammatory process in the urinary system, antibiotic therapy is prescribed.
If large stones are to be crushed, then a ureteral stent is installed before the procedure. Sometimes a specialist may prescribe additional examinations, such as computed tomography or intravenous urography, of which he notifies the patient at the consultation.
Remote nephrolithotripsy is usually performed without anesthesia, however, in the treatment of children, general anesthesia is most often used. Approximately twenty minutes before the start of the procedure, the patient is given infusion therapy, in which up to eight hundred milliliters of saline is injected intravenously by drip. During the operation, it may also be necessary to set up a dropper for intravenous administration of broad-spectrum antibacterial drugs.
For the procedure, the patient is placed on the back or on the stomach. At the location of the focus of the lithotripter, a special gel is applied to the patient’s skin, which improves the conduction of wave impulses.
With the help of an X-ray machine or ultrasound, the location of the stones is determined and the lithotriptor is focused. In order not to damage nearby tissues, this procedure is carried out under constant supervision. It happens that when the patient breathes, the stone changes its position and moves. In such cases, the wave energy impulses are synchronized with the person’s breathing.
The duration of the session is usually one hour, during which the patient is affected by about four thousand impulses, constantly gaining power. For crushing small fragments of stones, more than one session is not required, but if there are large stones, then three to five procedures are performed.
The effectiveness of the procedure and possible complications
It must be understood that remote nephrolithotripsy only contributes to crushing and removing stones from the body, but does not cure the patient from urolithiasis. To permanently get rid of the disease, constant consultations with a specialist urologist on the prevention and prevention of the formation of stones in the urinary tract and kidneys are necessary.
The effectiveness of the procedure can be affected by:
- the presence of a blockage in the urinary tract;
- the weight of the patient, with a large body weight, the effectiveness of lithotripsy is significantly reduced;
- density and chemical composition of stones;
- infectious process in the urinary system.
Often, after the procedure, antibiotics, painkillers and antispasmodics are prescribed.
It is necessary to drink at least one and a half liters of water every day, which helps to remove small crushed stones and the resulting sand from the kidneys and ureters.
Sometimes, during such a procedure, some adverse reactions may occur, presented in the form of an increase in body temperature, mild pain during urination, cramps, the presence of blood in the urine, and frequent urination.
It is also possible that some complications occur after such treatment: damage to the perirenal tissues, kidney hematoma, hematuria, obstruction or blockage of the urinary tract with stones.
Summing up
The method of remote nephrolithotripsy is considered one of the most popular and most effective methods for removing stones from the bladder and kidneys. Its use significantly affected the likelihood of possible complications in the postoperative period in this disease.
With the use of remote shock wave lithotripsy, the number of kidney operations, which were performed due to complications that arose during the crushing of stones in the genitourinary system, performed by surgical intervention, significantly decreased.