Urology - Extracorporeal Shock Wave Lithotripsy (ESWL)

What is Lithotripsy?

Lithotripsy is a non-invasive procedure used to treat stones in the urinary tract. It is proven as effective and efficient treatment for renal stones.

The Urologists at Salford Royal Hospital can provide you with more information regarding its indications and practical details on the use of lithotripsy. The following link will take you to further information.

https://www.baus.org.uk/patients/default.aspx

Efficient and patient friendly

The highly effective electro-conductive technology used in our lithotripter enables the urologist to successfully treat urinary tract stones without the need for an anaesthetic.

It is designed to fragment (break-up into small particles) urinary stones located throughout the urinary tract, kidney and ureter.

Results are dependent upon the position and composition of the stone. Successful fragmentation may require more than one session of lithotripsy treatment.

Following treatment, the fragments can pass out of the urinary tract through the urethra (water pipe) when you pass urine.

Lithotripsy does not work for all stones, therefore you may require an alternate treatment. The treatment option should have been discussed with you during the clinic consultation.

ESWL procedure

On the day of the procedure, you should attend Radiology 2 in the Ladywell Building at Salford Royal Hospital for the time stated on your letter, report to the receptionist and take a seat in the waiting area. A nurse will then call you in to the Lithotripsy suite.

You must expect to be in the department for 3 to 4 hours. We advise you not to drive following the procedure, therefore it is important that you have somebody to collect you after the procedure or you must get a taxi.

We also advise that you have somebody with you overnight at home and for the next 24 hours after the procedure.

The nurse will discuss with you what the procedure involves, how long it may last and what to expect during treatment. You will be asked questions regarding your medical history and any regular medications.

If you are currently taking any blood thinning medication, for example Warfarin or Clopidogrel, Apixaban, Edoxaban, Rivaroxaban, Ticagrelor, Aspirin, this must be stopped before the procedure. If this is not stopped within the correct time frame, you may not be able to have your procedure.

Aspirin can typically be continued if the dose is only 75mg. Higher doses should be stopped. Please arrange with your GP for INR testing if you are taking Warfarin before your appointment. Take all other regular medications.

Please call the Urology Specialists Nurses PA for advice on 0161 206 5380 from Monday to Friday 8am to 5pm.
 
Lithotripsy is not safe during pregnancy, therefore please inform the team if you are or could be pregnant.

Basic observations; blood pressure, pulse, oxygen saturations and temperature; are checked before commencing the procedure.

You will be asked to provide a urine sample, which will be checked to ensure that there are no signs of a urine infection.

An x-ray may be performed prior to commencing lithotripsy to check the visibility and position of the stone. The stone is targeted using x-ray imaging.

The nurse or doctor will confirm your consent to proceed with the treatment; discussing the benefits and risks of the procedure, as well as checking the side which is to be treated. You will have the opportunity to ask questions.

You will need to administer a suppository (form of pain medication inserted into the back passage and quickly absorbed into the blood stream). This will help to reduce any discomfort that you may experience throughout the procedure.

The lithotripter machine produces shock waves which are precisely focused on the stone. You will need to lie on your back against the treatment cushion which is in close contact with the skin. Lubricant jelly is used to improve the contact between the treatment cushion and the skin.

During the treatment you will hear and feel a tapping sensation from the lithotripter machine. Patient’s experiences of this will vary. Some feel very little discomfort and others may experience pain.
 
You can bring a personal earphone and mobile to listen to something relaxing as you will need to remain still throughout the procedure. There is no need to fast. Have a light breakfast or lunch.

Treatment starts at a low power and increases during the treatment session. The full treatment lasts between 45 and 60 minutes.

The nurse will be checking your blood pressure, pulse and oxygen saturations throughout the procedure. Approximately 3500 shockwaves are typically delivered during the procedure.

Some patients may require additional pain killers to be administered through a cannula (small blunt tube placed into a vein) in your hand to deliver the pain killer.

Once the procedure is complete, you will be asked to wait in the department to allow a period of recuperation.
 
The majority of patients will be discharged following the procedure as long as you are feeling well, and your observations are stable.

If you have had additional pain relief administered you will be asked to remain in the department for 30-60 minutes after the procedure, for a period of observation and until the pain relief has worn off.

ESWL after-care

It is important that after the procedure you rest, increase your fluid intake and take pain killers if required. You may notice some redness of the skin over the treatment area, blood in your urine: this is not unusual after treatment and can sometimes take a few days to settle. Please increase your fluid intake. Drink additional fluid for the next few days.

You may experience some pain as the particles pass and this is normally well controlled with oral pain killers such as paracetamol or ibuprofen.

If you become unwell with fevers, unsettled bleeding, uncontrolled pain with pain killers, then you should seek medical advice (GP, A&E department or Walk in centre).

It is not uncommon to develop a urinary tract infection after this procedure. If you experience burning, or stinging on passing urine, needing to pass urine more frequently, pain, or a temperature please see your GP and provide a urine sample as you may require antibiotics. If out of normal hours, please seek medical advice or contact out of hour’s GP.

You should not drive or drink alcohol for 24 hours if you have additional pain relief administered during the procedure.

You will be given verbal and written after-care guidance regarding what advice to follow the procedure and what to do if you become unwell.

Follow-up plan

After the procedure you will be given an open appointment for a repeat x-ray in 2 weeks’ time. Further appointment for ESWL treatment is arranged after this x-ray review.

About 80% of patients need more than one treatment. You will be given an appointment after 4 weeks for the second treatment if required.

You will receive a letter in the post with an appointment to be seen by the urologist to assess the result of the lithotripsy treatment.

Lead Consultant Urologists are Mr. Ross, Mr. Broome and Mr. Mukherjee.

You can also contact the urology department via email on:
Email: urologyappointments@nca.nhs.uk

All queries will be forwarded on to the appropriate urology nurse or secretary.