Extracorporeal Shockwave Lithotripsy

(ESWL)

<Management>

<Index>

 

 

 

Definition

-  Directed external shock wave through abdominal wall in order to pulverise Urolithiasis

 

Features

-  Minimally invasive

-  Greater success if

-  Radio-lucent stones

-  Stone <2cm

-  Proximal uretric stones vs mid or distal

 

Indications

-  Urolithiasis

-  Solitary kidney

-  Predisposed to ARF: HTN, DM..

 

Contraindications

-  Acute UTI or urosepsis

-  Pregnancy

-  Coagulopathy

-  Uncorrected distal obstruction to stone

 

Procedure

-  Pre-Procedure

-  FBE, U&E

-  INR, APTT

-  +/- Urine MCS

-  Renal US

-  +/- CT-KUB &/or CT-IVP

-  Patient lies on gantry

-  External shock wave device applied to site

-  Shoc waves applied

-  Post procedure

-  Hydration ++

-  Analgesia

-  +/- Tamsulosin

-  +/- Renal US or X-ray KUB 6/52 post

 

Complications

-  Acute urinary obstruction

-  Flank bruising

-  Haematuria: mild & transient

-  Renal colic

-  Stenstrasse: vertical build up of stone fragments withing ureter

-  Bacteruria

 

 

 

 

References

 

http://emedicine.medscape.com/article/444554-treatment