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What is lithotripsy?

Stones in the kidney can be treated in several ways, provided that your stone is suitable, Lithotripsy (or Extracorporeal Shock Wave Lithotripsy) is the first port of call. It is readily available when compared with surgery; it requires no general anaesthetic and is a day case treatment.

Lithotripsy treatment aims to fragment your kidney stone; the pieces created are then passed naturally in the urine. This information leaflet is intended to give you an idea about what is going to happen and the after-effects of this treatment.

 

Why do I need the procedure?

Your doctor has found that you have a stone or a group of stones in your kidney or ureter (tube that links the kidneys to the bladder). Kidney stones can be painful and cause infection or blood in your urine. If nothing is done to remove them, they may continue to grow and could damage your kidney or block your ureter.

 

What are the benefits?

Lithotripsy is a procedure that can be performed as a day case meaning that you can come into hospital, receive the treatment and go home the same day. It avoids the need for surgery and a general anaesthetic.

 

What to eat

The night before you come in for your treatment, you will need to eat a light meal. Avoid fatty fried or spicy foods as these can cause wind in the bowel which can affect the efficiency of the treatment.

From midnight the night before eat and drink lightly, eat a small breakfast or lunch prior to the treatment (depending on whether your treatment is AM or PM) keep hydrated but don't drink excessively as the oral pain killers we give you may make you feel nauseous and could make you vomit if you have a really full stomach.

 

Where to go

When you are offered your appointment for your lithotripsy treatment, you will be asked to attend the Admissions Lounge at St. Peter's Hospital, Chertsey. This is situated on the main corridor on level 3 not far from the escalator at reception. The Lithotripsy Suite is located in the out-patient area and you will be escorted to the Lithotripsy Suite once you have been prepared for treatment.

 

What will happen?

Before treatment you will be consented by a Urology Specialist Radiographer he will go through the procedure and the associated risks and possible side effects with you. It is good for you to know what these are prior to arrival:

Common (greater than 1 in 10)

  • Bleeding on passing urine for a short period after the procedure
  • Pain in the kidney as small fragments of stone pass after treatment (20%)
  • Urinary tract infection due to bacteria released from the stone during fragmentation, requiring antibiotic treatment (10%)
  • Need for repeated Lithotripsy treatments (15-20%)
  • Failure to fragment very hard stone(s) requiring an alternative treatment (up to 50%)

Occasional (between 1 in 10 and 1 in 50)

  • Stone fragments occasionally get stuck in the tube between the kidney and the bladder requiring hospital attendance and, occasionally, surgery to remove the stone fragments

Rare (less than 1 in 50)

  • Severe infection requiring intravenous antibiotics (less than 1%) and sometimes drainage of the kidney by a small drain placed through the back into the kidney
  • Kidney damage (bruising) or infection needing further treatment
  • Damage to surrounding organs by shockwaves requiring further treatment

(www.baus.org.uk)

 

You will be given some premedication in the Admissions Lounge and taken to Lithotripsy. Your treatment will be performed by a Urology Specialist Radiographer and Nurse.

The treatment begins with finding and targeting your stone with x-ray or ultrasound. When the treatment begins you will feel a gentle but sudden shock in your back whilst lying on a specially designed table in a thin layer of water, the intensity of the shocks increases over the 30- 40 minutes of treatment. We can of course stop the treatment if necessary.

 

What happens after the treatment?

You will be taken back to the Urology Centre after the completion of the treatment and from there, after a 30 minute to 1 hour recovery you will be allowed to return home by being collected by a family member or friend.

You will be supplied additional pain killers normally co-codamol on discharge.

You will either be booked for a 2nd treatment in 2 weeks or be booked in for an ultrasound and maybe an X-ray in 2 weeks depending on the size of the stone or the number of stones.

Once you are stone-free a follow up appointment with your Urologist will be made. If the stone has not fragmented after 2 sessions your case will be discussed in a multidisciplinary meeting to decide how to proceed.

 

What will I experience at home?

The treatment is designed to break the stone in smaller bits so you can pass them, the fragments are un-predictable in size, these can be large at times and can irritate your ureter- the tube that takes urine from the kidney to the bladder, this may result in pain, if so please take the tablets given to you. There will also be some blood in your urine, this is normal and may last up to 2 or 3 days. It is important to drink at least 2 litres of water a day between treatments to help flush through the fragments.

As you will have had pre-medication of in most cases oral morphine it is not recommended that you drive while you are still under the influence of the drug. If taking the prescribed discharge drug, most commonly co-codamol only drive if you feel that the drug is not influencing your ability to drive, it contains codeine and can make you light headed or sleepy if you have an accident while taking this drug you will be liable.

 

When to go to Accident and Emergency

If you have continuous severe pain that is not controlled by the pain killer that you have been prescribed, any heavy bleeding, or a high temperature, please attend your nearest Accident and Emergency Department preferably St. Peters with your discharge summary from your treatment.

 

Please note:

Always contact the Lithotripsy Radiographer on 01932 723124 at least two weeks before your procedure for advice on whether you need to stop your aspirin, clopidogrel or warfarin. Contact the above number if you have a Cardiac Pacemaker as extra precautions will need to be taken.

If there is a possibility that you may be pregnant you must tell one of the team as soon as possible as the x-rays or treatment could damage your baby.

If your doctor has prescribed medication for high blood pressure then please ensure that you take these tablets as directed before you come in for your procedure.

You will preferably need for someone to drive you home after the treatment, it is not recommended to drive a car.

If on the day of the treatment you are found to have a urinary tract infection (UTI) the treatment will postponed.

If in employment it is at your discretion and your employer's as to when you return however consideration needs to be taken regarding the potential pain arising from passing fragments in the 2 week window following treatment and also the effect on your ability to work while taking strong analgesia e.g. it would not be advised to operate machinery under the influence of co-codamol.

 

Emergency numbers:

St. Peter's Hospital Switch Board:
01932 872000

Urology Secretaries:
01932 723262 / 722376

Lithotripsy Radiographer:
01932 723124

Central bookings office:
01932 723739