Extracorporeal Shockwave Lithotripsy (ESWL) with optional sedation

Patient Leaflets Team

  • Reference Number: HEY-465/2021
  • Departments: Urology

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is lithotripsy?

You have been diagnosed as having a stone or group of stones in your kidney or within the tube (ureter) that drains the urine from the kidney to your bladder. These stones are formed when salts or minerals normally found in the urine become solid crystals which can get larger. Following discussion with your doctor, he has advised that your stones be treated with lithotripsy.

Lithotripsy is a procedure that uses shockwaves emitted from an electro-magnetic coil to break down kidney stones and is routinely performed as a day case. You can expect to be in hospital for up to three hours. The treatment itself usually takes around 30 – 40 minutes and can be uncomfortable. Many patients tolerate lithotripsy well without sedation but some people find the procedure too uncomfortable. The feeling is often described as like a small hammer or elastic band tapping on your back. It is also usual to experience a dull ache in your kidney region during the procedure.

Why do I need lithotripsy?

If your kidney stones are left untreated they may build up in your kidney and cause pain and infection. Occasionally the stone may block the kidney and cause damage or kidney failure. Lithotripsy offers a minimally invasive treatment. Alternatives to this treatment would be telescopic or open surgery under a general anaesthetic to remove the stone.

Can there be any complications or risks?

You should be assured that most patients do not suffer any problems after lithotripsy. However, most procedures have a potential for side effects, these include:

Common: (between 1 in 2 & 1 in 10 patients)
  • Blood in your urine (which can last several days)
  • Pain in your kidney as small fragments of stone pass
  • Need for further lithotripsy treatment to clear any stone(s) remaining
  • Failure to break the stone (which may need an alternative treatment)
  • Recurrence of stones in the future
  • Infection on your urinary tract
  • Bruising or blistering of the skin at the site of shockwave entry or exit
  • Some fragments may get stuck in your ureter (between the kidney & bladder) requiring surgical removal
Occasional (between 1 in 10 people and 1 in 100 people may experience)
  • Severe infection requiring injected antibiotics or drainage of the kidney with a small tube (nephrostomy)
  • Kidney damage with severe bruising
  • Inadvertent damage to the pancreas or lungs

How do I prepare for lithotripsy?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

You may eat and drink as normal. Please bring slippers, a dressing gown and a list of medication that you take with you into hospital. 

Please note: If you are taking clopidogrel or warfarin, you need to stop this medication one week prior to your lithotripsy appointment. You must check with your doctor that it is safe for you to do so. You will need to have a blood clotting test (INR) done by your doctor two days before your treatment to make sure that it is safe for you to receive lithotripsy.

You may take all other medication as usual.

Because X-rays are used to locate your kidney stone women should record the date of their last menstrual period and inform the nursing staff if they feel that there is any possibility they may be pregnant. Sometimes you may need an X-ray before your treatment to check that your stone has not moved.

On admission to the department the nurse will test your urine and check your blood pressure, pulse and temperature. You will have opportunity to discuss the treatment and ask any questions you may have.

What will happen?

Before your treatment starts you will be offered some sedation and pain relief medication which is administered through a needle in the back of your hand. If you do have sedation you should not drive home or use public transport and MUST arrange someone to collect you following treatment. For your safety we would also strongly advise that a responsible adult remains with you for 24 hours following the procedure. The sedation is not like having an anaesthetic but may make you feel drowsy during the treatment. It is not uncommon to remember very little about it. You may have the treatment without sedation and in this instance, you will be offered pain relief medication by another route. You will have opportunity to discuss this with the nurse and consultant when you arrive at the hospital.

You will be asked to change into a hospital gown and lie down on a couch. X-ray imaging or ultrasound will be used to pinpoint the exact position of the stone to be treated. A small amount of warm water will be poured underneath your back; this is to help ensure the accuracy of the shock waves. It is routine to attach you to some monitoring equipment and give you a small amount of oxygen to breathe. If you are having sedation the doctor will then put a small needle into your arm and give you the medicine. Once the treatment begins the intensity of the shockwaves is increased gradually. Try to lie still with your arms at your sides.  Please let the nurse or doctor know if you become too uncomfortable.

What happens afterwards?

You will need to rest on a couch for an hour until the effects of sedation have worn off. If you have not had sedation then you may not need to wait this long. You will be offered some refreshments and asked to pass urine before you are discharged. It is normal to see some blood in your urine for a few days as the kidney gets slightly bruised during treatment and you will be advised to drink plenty of fluids to help flush out any small fragments of stone. It is also normal to have some redness or slight bruising on your skin over your kidney. When you go home you will be given discharge advice and contact information along with a further appointment. Sometimes it may take several treatments to adequately break up your kidney stone or you may simply be asked to return to the stone clinic to check that your stone has completely gone.

When you arrive home, you should drink plenty for a few days to help flush any fragments through your system and to help minimise any bleeding or infection. It is normal to notice a small amount of blood (a pale pink colour) in your urine for 48 – 72 hours after your treatment.

It is advisable to make sure that you have some pain relief medication at home as you may feel some discomfort for a few days. Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Urology Day Services Department (01482) 622193
IF YOU DEVELOP A FEVER, SEVERE PAIN ON PASSING URINE, INABILITY TO PASS URINE OR WORSENING BLEEDING YOU SHOULD CONTACT THE UROLOGY DEPARTMENT IMMEDIATLEY.
YOU HAVE OPEN ACCESS TO THE WARD FOR 2 WEEKS FOLLOWING TREATMENT (01482) 623015

If you experience problems after this time you should contact your doctor.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

During the course of your procedure the radiology staff will ask questions that may appear unnecessary to you and these may be repeated at certain intervals. Please be assured that these questions are necessary to ensure that all aspects of your care during the procedure are maintained to a high standard.

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

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