C Extracorporeal shock wave lithotripsy
Extracorporeal shock-wave lithotripsy (ESWL) is a technique that uses high-energy shock waves to fragment renal calculi into small particles. A biplanar fluoroscopy unit is used to focus the shock wave on the target stone. The shock wave is repeated several thousand times and causes the stone to disintegrate. The focused, reflected shock wave passes through the water and enters the body through the flank.
Modern lithotriptors do not require the patient to be submerged in water. Although they do use water for the production of shock waves, a membrane over the shock-wave generator encapsulates the fluid. Transmission of shock waves to the patient is ensured by the use of coupling gel between the patient and the generator membrane.
2. Preoperative assessment and patient preparation
a) Routine preoperative assessment with laboratory tests based on any abnormalities found in the history and physical examination. Consider cardiac status; many hemodynamic changes are associated with this procedure.
b) Absolute contraindications are pregnancy bleeding disorders and abnormal coagulation parameters. Relative contraindications include these active urinary tract infection and a urinary tract obstruction distal to the stone that prevents passage of stone fragments.
c) Relative contraindications include aortic aneurysm, spinal tumors, orthopedic implants in the lumbar region, morbid obesity, AILD (automatic implantable cardioverter-defibrillator), uncontrolled arrhythmias, and coagulation disorders.
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