Extracorporeal Shock Wave Lithotripsy (ESWL) An information guide

Transcription

1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Extracorporeal Shock Wave Lithotripsy (ESWL) An information guide

2 Extracorporeal Shock Wave Lithotripsy (ESWL) What does the procedure involve? Firing shockwaves through the skin to break kidney stones into small enough fragments to pass naturally; this involves either xray or ultrasound to target the stone(s). What are the alternatives to this procedure? Alternatives to this procedure include telescopic surgery, open surgery and observation to allow stones to pass on their own. What should I expect before the procedure? You will be admitted to hospital on the same day as your surgery. It is helpful if you bring your own dressing gown to wear. You can have a light meal on the morning of your treatment but you should drink only clear fluid in the two to four hours before the treatment. Please tell your surgeon (before your surgery) if you have any of the following: An artificial heart valve A coronary artery stent A heart pacemaker or defibrillator An artificial joint An artificial blood-vessel graft A neurosurgical shunt Any other implanted foreign body 2

3 A regular prescription for warfarin, aspirin or clopidogrel (Plavix ) A previous or current MRSA infection A high risk of variant-cjd (if you have had a corneal transplant, a neurosurgical dural transplant or injections of human-derived growth hormone). When you are admitted to hospital, you will be asked to sign a consent form giving permission for your operation to take place if you haven t already, showing you understand what is to be done and confirming that you want to go ahead. Make sure that you are given the opportunity to discuss any concerns and to ask any questions you may still have before signing the form. What happens during the procedure? There is no anaesthetic or sedation given during this procedure, you will be awake throughout. Your treatment will be monitored by a lithotripsy technician. You will have a sensation like being flicked in the back by an elastic band. You may also feel a deeper discomfort in the kidney. Your treatment will normally last between 30 and 60 minutes, depending on the size of your stone(s). 3

4 What happens immediately after the procedure? You should be told how the procedure went and you should: ask the nurse if it went as planned; let the nursing staff know if you are in any discomfort; ask what you can and cannot do; feel free to ask any questions or discuss any concerns with the ward staff and members of the surgical team; and make sure that you are clear about what has been done and what happens next. You will normally be taken back to the ward to recover with a cup of tea or coffee and the Ward nurse will perform some routine post-operative checks. As soon as you have recovered, you will be able to go home. You may be given antibiotics and painkillers to take at home if these are required. Are there any side-effects? Most procedures have possible side-effects. But, although the complications listed below are well-recognised, most patients do not suffer any problems. Common (greater than 1 in 10) Blood in your urine for a short time after the procedure. Pain in your kidney as small fragments of stone pass (20%). Urinary infection due to bacteria released as the stone breaks (10%). Bruising or blistering of the skin. 4

5 Need for further ESWL treatment (15 to 20%). Failure to break very hard stone(s) which may need alternative treatment (less than 14%). Occasional (between 1 in 10 and 1 in 50) Severe infection requiring intravenous antibiotics (less than 1%) and drainage of the kidney by a small tube placed into the kidney. Stone fragments may get stuck in the tube between the kidney and the bladder; this may require surgery to remove the fragments. Rare (less than 1 in 50) Kidney damage (bruising) or infection needing further treatment. Recurrence of stones (less than 1%). Hospital-acquired infection Colonisation with MRSA (0.9% - 1 in 110). MRSA bloodstream infection (0.02% - 1 in 5000). Clostridium difficile bowel infection (0.01% - 1 in 10,000). The rates for hospital-acquired infection may be greater in highrisk patients, for example those patients with long-term drainage tubes; who have had their bladder removed due to cancer; who have had a long stay in hospital; or who have been admitted to hospital many times. 5

6 What should I expect when I get home? When you are discharged from hospital, you should: be given advice about your recovery at home; ask when you can begin normal activities again, such as work, exercise, driving, housework and sex; ask for a contact number if you have any concerns once you return home; and ask when your follow-up will be and who will do this (the hospital or your GP). When you get home, you should drink twice as much fluid as you would normally. This helps to flush your system through and minimise any bleeding or infection. You may take painkillers when necessary and you must complete the prescribed course of antibiotics if these are given. You may see blood in the urine for 48 to 72 hours. If you develop bruising or blistering on your skin, you can apply simple skin creams to ease any discomfort. This bruising normally disappears within seven days. What else should I look out for? If you develop a fever, severe pain on passing urine, you cannot pass urine or your bleeding increases, you should contact your GP immediately. Small blood clots or stone fragments can pass down from the kidney, resulting in renal colic. If this happens, you should contact your GP immediately. 6

7 Are there any other important points? You will be informed about any follow-up arrangements before you go home. This may involve further lithotripsy, surgery or an appointment for a further X-ray. If you have an ureteric stent in place, you may get an appointment for removal of the stent under local anaesthetic. You can reduce the risk of further stones by changing your diet and increasing your fluid intake. If you have not already received a leaflet about this, contact your specialist nurse or your consultant. Driving after surgery It is your responsibility to make sure you are fit to drive following your surgery. You do not normally need to tell the DVLA that you have had surgery, unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to give you advice on this. 7

8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: April 2008 Date of review: May 2017 Date of next review: May 2019 Ref: PI_SU_434 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests