FAQs

What to do following the treatment

There are no restrictions after the treatment session- you may continue with your normal activities. You may use simple painkillers if still in pain. Do not use anti-inflammatory medication on the treated area as it will affect the body’s inflammatory and healing process stimulated by the shockwave treatment.

Pain relief may be felt immediately but long term effects are normally seen after 3 months.  All patients should be reviewed after 6-12 weeks by their referring clinician after having completed the course of shockwave treatment.

Reference:

  • homerton.nhs.uk/sport

Are there any Contraindications or Precautions to be aware off

ESWT is not allowed if you are pregnant.

ESWT application is also not indicated if the following criteria apply:

  • Lung tissue in direction of sound fields
  • Presence of a Cardiac pacemaker
  • Has had a Cortico-Steroid injection in the area in past 3 months
  • Over or near bone growth centers until bone growth is complete
  • Malignancy is known to be present in or near the treatment area
  • Treatment site has open wounds, skin rashes, swollen, inflamed, or infected areas
  • Over ischemic tissues in individuals with vascular disease
  • Coagulation disorder or taking anticoagulant/antiplatelet medications
  • Infection at the treatment site to avoid the risk of spreading
  • History of latex allergy or allergy to coupling solution

What are the criteria for referral for ESWT

All patients must have had some imaging to confirm diagnosis prior to ESWT. Patients must have an on-going tendinopathy for more than 6 months and have failed at least one course of conservative treatment such as physiotherapy, injection therapy or orthotics.

Is the shockwave treatment painful

The treatment itself can be painful during the application of the ESWT. The treatment is delivered according to patient response, if a patient is unable to tolerate the pain levels the settings will adjusted to reduce the discomfort. A mild ache may occur later that day but should pass after a day. A patient may therefore take analgesic pain relief afterwards if required or before attending their next session.

How long does the treatment session last

The ESWT application lasts 3-4 minutes to deliver the set 2500 impulses of shockwave energy and you must attend for 3 sessions over 3 consecutive weeks.

Why chose ESWT

Shockwave therapy stimulates and supports the body’s self-healing mechanisms.  ESWT is a non-invasive treatment modality- there are no medications such as cortisone or surgery involved. There are no major safety concerns associated with ESWT. It is common to have some immediate pain relief and studies have shown positive outcomes in approx. 70% of cases. It is included in the NICE guidelines for the management of refractory (chronic) tendinopathies involving conditions such as plantar fasciitis, Achilles tendinopathy and tennis elbow but can be used for most common tendinopathies.

How is the shockwave delivered

The painful area is located by palpation. The treatment is delivered via a compressed air impulse through a hand held piece attached to the shockwave machine. The shockwave radiates out through the head into the affected area. Contact gel will be applied to the skin to improve the transmission of the shockwave.

How does it work

The treatment initiates a pro inflammatory response in the affected tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the affected area which accelerates the body’s own healing processes. The shockwaves can break down injured tissues and calcifications. As a result of cellular tissue micro-trauma, it can provide a temporary analgesic effect on afferent nerves providing immediate pain relief, known as ‘hyper-stimulation anaesthesia’.

What is it

Extracorporeal Shockwave Therapy (ESWT) is a non-invasive treatment in which a device is used to pass acoustic shockwaves at a set frequency through the skin to the affected area. It is purely a mechanical wave- not an electric one. Shockwave is an accepted intervention in the UK and treatment may provide pain relief for chronic tendinopathies.

When should you call doctor

Call if you:

  • Have a temperature greater than 100 degrees F or chills.
  • Find that the pain medicine is not reducing your pain.
  • Cannot tolerate food or fluids.
  • If you have excessive blood in the urine, which is typically red, thick and cannot see through it (like ketchup), or if you have blood clots in your urine that make it difficult to urinate, please contact your physician immediately.
  • Some blood in the urine is normal after a PCNL procedure.

https://www.mykidneystone.com/content/dam/bostonscientific/uro-wh/patientSites/myKidneyStone/treatmentOptions/pcnl/PCNL-Patient-Brochure.pdf

What can be done to prevent more stones

There are steps to follow to prevent stones from coming back:

  • Drink plenty of fluids.
  • Restrict your sodium intake.
  • Maintain a healthy weight.
  • Take medicine
  • Some patients need medicine to help reduce their risk of developing another kidney stone.
  • Make dietary changes, such as reducing the intake of soft drinks, animal protein and salt.

If patient goes home with a stent, what may be the common side effects

  • Blood in the urine
  • Drinking fluids helps to reduce blood clots from forming in your urine
  • Feeling of fullness and a constant need to urinate (urgency and frequency)
  • A burning sensation during urination or when you move about.
  • Bladder muscle spasms.
  • At a follow-up appointment, typically 4 to 14 days after the procedure, the doctor removes the stent. Patients are usually awake when a stent is removed. Doctor may apply a local anesthetic jelly to the opening of your urinary tract (urethra) before the procedure. If it has a string attached, the doctor pulls on the string to remove the stent. Or, doctor may use a small scope inserted into the bladder to take out the stent.

What is uretral stent

A ureteral stent is a small plastic tube that is placed in the urinary tract to help control swelling and allow the kidney to drain urine. The stent typically remains in your body for 4 to 24 days and is then removed during a follow-up appointment.

If patient goes home with a nephrostomy tube and drainage bag, what happens

  • Bloody urine is common.
  • But if the bleeding increases significantly, contact doctor immediately or return to the emergency room for further evaluation.
  • Empty the drainage bag before it gets full. If the bag no longer drains urine and you experience back pain, call your doctor immediately.
  • The tube may be blocked or loose. You may notice leakage of urine around the tube and may need to change the dressing.It’s okay to shower with the bag. It can get wet. However, you must keep the incision site covered with a waterproof dressing.
  • Several days after discharge from the hospital, you will go to the doctor’s office for removal of the tube. If you go home with a ureteral stent, your doctor will remove it during a follow-up appointment 4 to 14 days after your procedure.

What is a nephrostomy tube

A nephrostomy tube is a catheter placed in the kidney that connects to a drainage bag to collect urine outside of your body. The nephrostomy tube is usually removed prior to hospital discharge. Sometimes patients go home with the nephrostomy tube and it is removed several days later during a follow-up appointment.

What should you expect after the procedure

Common side effects include:

  • Nausea and occasional vomiting.
  • Pain is common for the first 24 to 48 hours in your kidneys, abdomen, lower back and sides.
  • Pain may increase when you urinate.
  • Take medicine as prescribed.

What happens during the procedure

  • A PCNL typically lasts one to three hours.
  • After patient is under anesthesia, the doctor makes a small incision in the back.
  • The doctor inserts a protective sleeve called a sheath through patient’s back and into kidney.
  • The doctor then passes a video scope called a nephroscope through the sheath to locate and remove the kidney stones.
  • To help kidney heal and drain urine during the healing process, doctor may place a nephrostomy tube or a ureteral stent at the end of the procedure.
  • Some patients require a second operation to remove all of the stone. If so, the nephrostomy tube and stent may be left in place until the next operation.

What should I do before the procedure

There are three important things to do before your procedure:

  • Talk with your doctor. Let your doctor know all of your prescription medicines, vitamins and supplements, herbs and natural remedies, and over-the-counter drugs.
  • Any known allergies you have to medicines and the contrast agent used in some X-rays.
  • If you may be pregnant.

What is percutaneous nephrolithotomy (PCNL)

A percutaneous nephrolithotomy, or PCNL, is a kidney stone surgery for large or multiple stones. The doctor performs the surgery in a hospital operating room. It usually requires a hospital stay of one to two nights.

What are the risks

Complications of ESWL include:

  • Pain caused by the passage of stone fragments.
  • Blocked urine flow as a result of stone fragments becoming stuck in the urinary tract. The fragments may then need to be removed with a ureteroscope.
  • Urinary tract infection.
  • Bleeding around the outside of the kidney.

References:

How do I know if ESWL was successful

Several weeks following ESWL treatment, urologist will perform a follow-up X-ray to determine whether the stone was broken up into small pieces and if those small pieces passed out of the kidney. If the stone has broken up into small fragments but the fragments have not cleared, the X-rays may be repeated again after another several weeks.
If the stone has not broken up into small fragments, your urologist will likely recommend further treatment. In most cases, if the stone does not break up following one ESWL treatment, more ESWL treatments are unlikely to be successful. In this situation, other treatments, such as ureteroscopy or percutaneous nephrolithotomy, may be recommended.

What does ESWL procedure involve

Firing shockwaves through the skin and focusing them down to break kidney stones into small enough fragments to pass naturally; this involves either x-ray or ultrasound to target the stone(s).

Why ESWL is done

ESWL may be used on a person who has a kidney stone that is causing pain or blocking the urine flow. Stones that are between 4 mm (0.16 in.) and 2 cm (0.8 in.) in diameter are most likely to be treated with ESWL.

ESWL may work best for kidney stones in the kidney or in the part of the ureter close to the kidney. Surgeon may try to push the stone back into the kidney with a small instrument (ureteroscope) and then use ESWL.

What to Expect prior to the Surgery

Once surgical date is secured, the following preoperative tests are done prior to the surgery:

  • Physical exam
  • Electrocardiogram (EKG)
  • Complete blood count (CBC)
  • Blood coagulation profile (PT/PTT)
  • Comprehensive metabolic panel (blood chemistry profile)
  • Urinalysis

What happens on the day of the procedure

The procedure is usually performed by a urologist or a lithotripsy technician. Patient will be asked for a urine sample (to check for infection) and may have an X-ray to make sure your stone has not moved. Patient can have a light meal on the morning of the treatment but should drink only clear fluid in the two to four hours before treatment.

What are the details of the procedure

  • Patient will be awake throughout the procedure
  • They position patient on the treatment couch with either gel or water applied to the skin to ensure good contact with the shockwave generator
  • The machine fires pulsed shock waves once the stone has been pinpointed using X-rays or ultrasound
  • Patient should try and lie as still as possible during the treatment.
  • Each shock wave creates a sensation like being flicked in the back with an elastic band
  • Doctor can give additional painkiller or sedation if the treatment proves very painful
  • Treatment normally lasts 30 to 60 minutes, depending on the size of the stone
  • Patient will be able to go home within a couple of hours but should not attempt to drive himself home.

What to expect after discharge from the hospital

  • Pain control: Patient can expect to have some incisional discomfort that may require pain medication for a few days after discharge.
  • Bleeding: It is normal to see blood in the urine for several weeks after surgery.