Friday, May 14, 2010

ESWL:Non-Invasive treatment for stone fragmentaion

We had one 35 year old gentleman who presented to us with the bilateral renal calculi 1-1.5 cm with normal functioning kidneys.He was prestented in a view if the stones donot get fragmented with ESWL then after 4 weeks ,Retrograde Intra Renal Suregry (RIRS) can be done.
During the procedure there was good fragmentation.He is planned for review after 4 weeks and imaging at the same time.

Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy
ESWL or extracorporeal shock wave lithotripsy has revolutionized the treatment of renal stones. Kidney stones less than or equal to 1.5 cm in size in the kidney or upper ureter are best treated with ESWL.
Usually, this is an outpatient type of procedure using IV sedation or full anesthesia.

Treatment time runs from 1 to 2 hours. The stone is usually visualized with fluoroscopy and once centered for treatment, a shock wave is generated that penetrates the body and impacts upon the stone. After usually 3000 shocks are given, the stone gradually pulverizes, and the fragments are passed spontaneously over the next several days to weeks (It may sometimes take upto 3 months to pass all the fragments).

Complications of this procedure bleeding which is self resolving, infection so peri-procedure cover of antibiotics is essential. The third potential complication is sometimes the stone breaks and the gravels line up along the lower ureter making it necessary for the patient to undergo secondary/auxialiary procedure- Ureteroscopic clearance.
As with any procedure; pre-operative urine culture should be sterile and the patient should be off from the anti-platelet agents atleast for the 7 days for the safety otherwise large hematomas not only in kidneys but also in liver and adjacent organs are reported.

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