Kidney Stones - United Shockwave Services

What is Lithotripsy | FAQs | Pain Management | Pre-Procedure | Post-Procedure

What are Kidney Stones?

A kidney stone occurs when salts and other minerals in urine stick together to form a hard, crystalline mass. They can range in size from a grain of sugar to a golf ball. Smaller kidney stones may pass unnoticed through the urinary tract but other, larger stones may block the flow of urine and cause symptoms such as:

Extreme pain in your back or side that will not go away
Pain urinating
Persistent need to urinate
Vomiting or nausea
Blood in your urine
Fever and chills if infection is present
Reduced amount of urine

Treatment for kidney stones varies depending on the specific type of stone and the cause. For some patients, lithotripsy is an effective therapy to treat symptomatic kidney stones.

Make an appointment with your health care professional if you have any signs or symptoms that cause concern.

What is Lithotripsy?

Extracorporeal shock wave lithotripsy, often referred to as ESWL or simply lithotripsy, is a common, non-invasive procedure used to treat stones in the kidneys, bladder or ureter (the tube that carries urine from the kidneys to the bladder). The procedure uses safe high-energy sound waves to break stones into pieces small enough to pass out of the body through the urine.

FAQs

Can kidney stones damage my kidneys?

Can kidney stones recur?

What can I do to prevent future kidney stones?

If you have had kidney stones before, you are more likely to have kidney stones again. To help keep future stones from forming, try to:

Drink 6 to 8 glasses of water each day
Spread out your fluid intake as evenly as possible throughout the day. This keeps the urine from becoming concentrated and reduces the chance that crystals – the building blocks of kidney stones – will form. Since the goal is to produce at least 2 quarts of urine a day, you should drink more fluid in very hot weather to make up for that lost by sweating.

A good way to judge whether you’re drinking enough is to watch the color of your urine. If your urine is dark and yellow, drink more. It should be pale, almost watery. Urine has more color in the morning when it is most concentrated, but the rest of the time, the less color the better.

Drinking plenty of fluids also reduces the risk of urinary tract infections – a major cause of struvite stones. Any infections that do occur should be treated promptly and completely.

Eat less salt (sodium), meat and eggs
Depending on the kind of stone involved and the results of laboratory tests, your doctor may advise you to eat less of certain kinds of foods. For example, patients with calcium oxalate or uric acid stones may need to reduce the amount of meat products and table salt in their diets and increase the amount of fiber. You and your physician may work with a dietitian to develop a diet suited to your particular needs.

Talk to your doctor about medications and other tests for kidney stones
Prescription medications may help some patients. Diuretics, such as hydrochlorothiazide, decrease calcium excretion. Potassium citrate binds calcium and helps to remove it safely. Allopurinol, which causes the body to produce less uric acid, is sometimes prescribed for patients with gout. It also reduces their risk of forming uric acid or calcium oxalate stones.

But patients taking medications still need to drink at least ten 8-ounce glasses of fluid per day. When cystine stone formation can’t be controlled by increased fluid levels alone, penicillamine or tiopronin may be prescribed to make it easier for the body to dissolve cystine. Other specific medications may be prescribed by your doctor.

Do NOT reduce the calcium in your diet without talking to your doctor first. Studies show that limiting calcium in your diet may not stop kidney stones from forming and may harm your bones.

Feel free to discuss these and any other questions you have with your doctor.
Remember, the single most important way to help prevent kidney stone formation is to stay well hydrated.

What are some complications or side effects of lithotripsy?

Lithotripsy is considered a safe procedure. But as with all medical treatments, there are some risks involved. Specific risks include:

– Discomfort as stone fragments pass through urinary tract
– Blood in the urine
– Bruising on the back or abdomen
– Bleeding around the kidney or adjacent organs

Talk with your doctor for a better understanding of the benefits and risks of lithotripsy to treat your kidney stones.

How long will the lithotripsy procedure take?

Why do I need a driver?

When can I go back to work?

When can I resume sexual relations?

What is a stent? Will I need one?

A stent is a sterile hollow flexible tube that the physician places into the kidney drainage system. This allows the kidney to drain around the pieces of stone. It also continues to drain the kidney as you pass the stone fragments created by the lithotripsy procedure.

The stent needs to stay in until the majority of the stone fragments have been passed, which can be approximately one to two weeks.

Your doctor will determine whether you need a stent based on stone size, location and other symptoms, such as pain or infection.

What can I expect when I go home?

Will I need a second treatment?

United Therapies has one of the lowest retreatment rates in the country, meaning that it’s likely you will need only one lithotripsy treatment to successfully resolve your kidney stone.

However, every patient and every stone is different. Lithotripsy results are influenced by patient size, stone type and density, anatomy and other variables so in occasional circumstances multiple treatments may be necessary.

How do I know if I’m dehydrated?

Thirst is the last indicator that you are low on fluids. Once you are thirsty, you are already dehydrated. If you urinate infrequently and/ or your urine is a dark yellow to amber color, the urine is concentrated. This means you are dehydrated. A good rule is to drink 8 ounces of water every time you urinate, replacing the water that you just lost. Keep in mind that if you consume coffee, tea and colas you increase your chances of being dehydrated because caffeine may act as a diuretic.

I’ve heard I should drink a lot of cranberry juice. Is that true?

Pain Management

While at our Centers, we work with you to control and manage any pain you may experience. Our anesthesiologists will administer sedation through an IV to control any pain you may have during the procedure.

While in the recovery room you will be asked to rate your pain on a scale of zero to ten (0-10), with zero (0) meaning no pain and ten (10) meaning severe pain. Your healthcare providers may also use the visual charts below to help you describe your pain.

Depending on the type, size and cause of your kidney stone, the treatment your health care provider recommends will vary. Most kidney stones will not require surgical treatment.

To aid in passing small stones, your health care provider may advise you to:

Drink adequate fluids
Unless advised otherwise by your physician, try to drink as much as 2 to 3 quarts of liquid – mostly water – a day to help flush the urinary system and move the stone along. You should be drinking enough to produce clear or nearly clear urine.

Apply heat
You may find temporary relief by applying a heating pad on the area where you are experiencing pain. A hot shower with the spray directed at the painful areas may also help. The heat helps ease muscle tension in the afflicted area, possibly helping the stone to work its way through the system.

Over the counter pain relievers
Passing even small stones can cause discomfort. Your doctor may recommend using nonprescription pain relievers such as acetaminophen to ease pain.

Prescription medication
If your doctor determines that you need help to pass your kidney stone, he or she may prescribe a medication known as an alpha-blocker to relax the muscles in your ureter. This helps you pass the stone more quickly and with less pain.

Pre-Procedure Instructions

Three to five days before your procedure with United Shockwave Services, a nurse will contact you to confirm the date and time of your appointment, review your medical history and cover pre-procedure instructions.

If you do not hear from a member of the nursing staff within 24 hours of your procedure, please call the center at which your procedure is scheduled immediately. Find your center’s contact information here.

To prepare for this call and your procedure, we request that you:

Check with your physician to review your prescription and non-prescription use and whether any medications should be stopped or avoided prior to the procedure.
Do not take any Non-Steroidal Anti-Inflammatory medicines (NSAIDS) like Ibuprofen (Motrin, Advil), Naprosyn, Aleve or Toradol or any Aspirin or Aspirin products for seven (7) days prior to your procedure, unless otherwise instructed by your physician. Please stop taking herbal medications or dietary supplements at this time as such medications may increase the risk of bleeding during the procedure.
Please stop taking herbal medications or dietary supplements at this time. Such mediations may increase the risk of bleeding during the procedure.
Address any of your questions or concerns with your physician.
Make arrangements for transportation to and from the Center with a responsible family member or friend. You will not be allowed to drive yourself home or be discharged without a responsible adult.
The procedure takes approximately one hour and you will spend about one hour in the recovery room prior to discharge.

Prior to the procedure:

Do not eat or drink anything after midnight prior to your procedure
Take your regularly scheduled medicine the night before the procedure. Medications for high blood pressure, heart, seizures and asthma (please bring your inhaler to the procedure) should be taken early morning with a small sip of water. The nurse will verify this with you during the pre-op phone call.
Shower or bathe the morning of the procedure. Wear loose comfortable clothing and leave your jewelry and valuables at home.

For kidney stone patients only:

The night before your procedure take 80 mg Simethicone (e.g., Mylanta Gas, Gas-X – an over-the-counter medication available at any drug store) to help reduce bowel gas and better visualize the stone on x-ray.
Bring the following on the day of the procedure: Insurance card, claim forms or HMO referral, drivers license/photo ID, payment as instructed by our insurance verifier and x-rays, if applicable.

As always, our staff is here to assist you before, during and after your procedure. Please contact us if you have any questions.

Post-Procedure Instructions

The purpose of the Extracorporeal Shockwave Lithotripsy (ESWL) procedure is to break up kidney stones into small, sand-like pieces that may pass easily through your urine but lithotripsy does not actually remove the kidney stones from your body.

After your lithotripsy procedure:

You may experience discomfort, redness, bruising, abrasions or pain at the treatment site from the shock waves. There may also be discomfort or mild pain as pieces of stone pass through the ureter. A prescription pain medication, or extra-strength pain reliever, may be prescribed for you.
An antibiotic may be prescribed for the treatment or prevention of a urinary tract infection. Finish all prescribed antibiotics after your procedure.
Unless your doctor advises otherwise, most patients should be able to return to their normal activities within 24 to 48 hours.
Drinking a lot of fluids, along with mild exercise, may help stone pieces pass through your body.
Straining urine after the procedure may help your doctor study your kidney stone pieces. Some patients will not pass pieces immediately, but may do so four to six weeks after the procedure. These particles may be very small, or similar to sand, and can be brown, tan or black.
Your doctor may ask you to have new X-rays taken before your first follow-up appointment. This x-ray will help the doctor see how well your kidney stones broke apart. Occasionally, X-rays will reveal additional, or larger, kidney stones. Another ESWL treatment may be needed to break up additional or remaining stones.
If you have a stent, your doctor will tell you when and where to go for removal of your stent. You may experience pain when your stent is removed.
Additional procedures may be necessary as part of your treatment for kidney stones. These procedures include cystoscopy, stone manipulation or basket extraction and may be done just before the lithotripsy. Other procedures, such as ureteroscopy or placement of a percutaneous nephrostomy (a tube inserted into the kidney through the back), may be done at your own hospital. These additional procedures help the doctor best treat your kidney stones.
Most patients will be stone-free three months after the ESWL procedure, but a few will still have sand- like pieces in their kidney. Some of these pieces may continue to pass, but others may remain in the kidney.
Bleeding around the kidney has occurred in some patients after an ESWL procedure. Though rare, in these cases a blood transfusion may be needed.
ESWL will not stop new kidney stones from forming.
Bring your x-ray back to your post procedure appointment.