The job of the kidneys is to filter chemicals/ waste products that the body does not require, out of the blood into urine. When the kidneys are healthy, the waste products are dissolved in the urine and passed out. But under certain conditions, the chemicals may come together and from crystals. These crystals stick together and grow to form a “stone” Kidney stones may block the flow of urine through that part of the urinary tract, causing severe pain. Occasionally, kidney stones may exist in  both kidney, risking complete stoppage of urine, this may become on acute  emergency. Kidney stones may sometimes present with severe backache; sometimes with blood in the urine; sometimes with urinary tact infection and at times only with high blood pressure.

LITHOTRIPSY INTRODUCTION

(litho = stone; tripsy= to break)

Lithotripsy is  a method crushing a kidney stone while it is still inside the body. It is non-invasive method that does not require any cut or hole. During lithotripsy, carefully directed shock waves pass harmlessly through the body and hit only the stone, causing it to crumble into sandlike particles. These particles are then passed out of the urinary tract.

Advantages

·     O.P.D. Procedure

·     Painless

·     No Scars

·     Cost Effective

·     Excellent Lithotripsy with lates Direx NOVA ULTIMA Lithotriptor giving finer fragement, easier to pass out.

·     Excellent Localisaiton with the DIREX Automatic Image Intensifier modal Digiscope 9”-therefore, suitable in both renal & ureteric calculi.

POSSIBLE COMPLICATIONS

Complications of lithotripsy are very rare, almost unknown, but include the following:

·     Infection

·     Bleeding of the kidney

·     Bruising of the skin

·     Obstruction of the ureter (the passageway from the kidney to the bladder)

·     Failure of the stone of fragement.

CONTRA INDICATIONS

Lithotripsy is usually safe for patients from the age of 2 years onwards. Absolute contraindications include pregnancy and bleeding disorder; infection in the kidney due to the stone may first need to be treated by medicines or by “DJ Stenting”. Stones with non functioning kidney obviously will be unsuitable for lithotripsy as the fragments will not be passed out. Anatomoical obstruction of the urinary system distal to the calculus may need additional treatment.

HOW IT IS DONE

The lithotripsy procedure, which taken about on hour, is done on OPD basis, usually without anesthesia. Some analgesia and sedation may be given to allay the patient’s anxiety and make him relax or go to sleep. The stone is localised with the image intensifier to (a form of X-ray) and then the shock waves are focused on the stone. The patient may feel a tapping sensation when the shock waves pass harmlessly through  the body. If large stone particles remain after treatment, a second sitting may be required after 7-10 days.

AFTER THE PROCEDURE

After the procedure, the patient will be monitored for  an hour or so, after which he will be allowed to go home or even to work. He will be required to take a lot of fluids and some mid pain killer and antibiotics if necessary. If may take a few days to several weeks for the stone particles to be completely  passed out. It is normal for the urine to be cloudy or blood stained for the first few days. It is a good idea to stain the urine for the first few days and pick up the gravel which is passed out. This is usually  tested subsequently and helps in planning dietary control to prevent recurrences.

Usually, a routine urine  examination of KUB X-ray may be required after 10 days to check for complete stone clearance.

WHEN TO CONTACT THE DOCTOR

Usually the patient does not experience any difficulties and can follow up with his doctor 7-10 days. However, the patient may need to contact the doctor urgently if he has any of the following:

·     Fever over 100.4F

·     Heavy bleeding

·     Pain not relieved by pain medication

·     Difficulty in urination

COMMONLY ASKED QUESTIONS

Q.      Is lithotripsy safe?

A.      Lithotripsy is absolutely safe in almost the patients. Complications are very rare, Morality following ESWL is virtually unknown.

Q.      Will there be pain after the treatment?

A.      Due to passage of small blood clots or stone fragment, colicky pain may occur for the first few days but the usually, responds to medications.

Q.      Is there any damage to the kidney or other organs during lithotripsy?

A.      Due to precise localisations the shock waves are focused directly at the calculus. Also, the shock waves are ineffective on tissues which contain fluid. Skin, muscle, kidney, etc., have a high water content and hence the shock wave energy passes through harmlessly through them.

Q.          Which is the better-localisation with large intensifier or wit sonography/

A.          Localisation with image intensifier (X-ray) is faster, sharper  and more accurate. Also, it is useful to have on X-Ray based lithotripsy as the stone fragments may come into the ureter and require lithotripsy in the ureter. It is very difficult and almost impossible to localise the stone fragments in the ureter with a sonography based lithotriptor. There is  definitely radiation used during the lithotripsy, but this minimised by accurate localisation and protection of sensitive areas with lead barrier.

Q.      Is the treatment possible in patient with diabetes, blood pressure, heart disease or renal failure?

A.          Lithotripsy, is a non invasive procedure. Obviously, risks with lithotripsy are much lower for these patients compared to surgical treatment. Lithotripsy is strongly advanced for patients with these medical problems requiring stone clearance.

Q.      After lithotripsy, will the stone recur?

A.          lithotripsy, like open surgery, aims at removing the stone completely. However, as in open surgery, the patient may develop recurrences if the patient does not control his diet and take large quantities of fluid.

Q.      How do you prevent stone recurrence?