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    Extracorporeal Shock Wave Lithotripsy (ESWL (

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    emirilejla
    Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for breaking up kidney stones and certain types of ureteral stones. ESWL uses focused shock waves to break stones into smaller fragments that can pass through the urinary system. The procedure involves using an ultrasound or fluoroscopy to locate the stone, applying gel to the skin to transmit shock waves, and increasing the shock wave power until the stone is broken into pieces small enough to pass. ESWL is generally safe and effective for treating stones less than 2 cm in the kidney or 1 cm in the ureter, but may require multiple treatments and cause pain.

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    Extracorporeal Shock Wave Lithotripsy (ESWL (

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    emirilejla
    32 views31 pages
    Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for breaking up kidney stones and certain types of ureteral stones. ESWL uses focused shock waves to break stones into smaller fragments that can pass through the urinary system. The procedure involves using an ultrasound or fluoroscopy to locate the stone, applying gel to the skin to transmit shock waves, and increasing the shock wave power until the stone is broken into pieces small enough to pass. ESWL is generally safe and effective for treating stones less than 2 cm in the kidney or 1 cm in the ureter, but may require multiple treatments and cause pain.

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    extracorporealshockwavelithotripsyeswl-160612223705

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    Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for breaking up kidney stones and certain types of ureteral stones. ESWL uses focused shock waves to break stones into smaller fragments that can pass through the urinary system. The procedure involves using an ultrasound or fluoroscopy to locate the stone, applying gel to the skin to transmit shock waves, and increasing the shock wave power until the stone is broken into pieces small enough to pass. ESWL is generally safe and effective for treating stones less than 2 cm in the kidney or 1 cm in the ureter, but may require multiple treatments and cause pain.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    32 views31 pages

    Extracorporeal Shock Wave Lithotripsy (ESWL (

    Uploaded by

    emirilejla
    Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for breaking up kidney stones and certain types of ureteral stones. ESWL uses focused shock waves to break stones into smaller fragments that can pass through the urinary system. The procedure involves using an ultrasound or fluoroscopy to locate the stone, applying gel to the skin to transmit shock waves, and increasing the shock wave power until the stone is broken into pieces small enough to pass. ESWL is generally safe and effective for treating stones less than 2 cm in the kidney or 1 cm in the ureter, but may require multiple treatments and cause pain.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    Extracorporeal shock

    wave lithotripsy (ESWL(


    DONE BY : MUSTAFA KHALIL IBRAHIM
    TBILISI STATE MEDICAL UNIVERSITY

    4th year, 1st semester, 2nd group


    ESWL Stone
    Machine Body
    Crystallizationof
    minerals inside urine,
    which act as the nidus
    for more
    sedimentation and
    finally the formation of
    a stone within the
    kidney.
    Calcium-containing stone
    Calcium Oxalate
    Calcium Phosphate
    Uric acid stone
    Cysteine stones
    NO symptom
    Pain: sudden or severe pain
    nausea, vomiting
    Renal colic
    Frequent and painful urination,hematuria
    Urinary tract infection: Block the urinary
    tract
    Ultrasound CT

    Plain X-ray

    Intravenous
    Urogram
    ESWL
    Percutaneous nephrolithotomy
    Ureteroscopy
    Open surgery
    Use focusing Shock Waves to
    breakdown
    a stone into small pieces.
    Shock waves are acoustic
    pulses.
    Pass through better in water
    and solid but
    not in air.
    Introduce in 1980 by
    Dornier which is a
    supersonic aircraft company
    Indication Contra-indication

    Stones of less than 2 cm in the kidney


    Relevant coagulation problems
    Or
    less than 1 cm in the ureter. Lung tissue in shock wave path
    Tumors in shock wave area
    Aneurysms
    Polyarthritis (difficult to positioning)
    Active pyelonephritis
    Pregnancy
    1) A shockwave generator (electromagnetic generator)
    2) A focusing system
    3) A coupling system
    4) An imaging/localization units
    Provide a air-free contact
    In the propagation and transmission of a
    wave, energy is lost at interfaces with
    differing densities.
    A coupling system is needed to minimize
    the dissipation of energy of a shockwave
    as it traverses the skin surface
    Transcranial magnetic stimulation Dornier
    Fluoroscopy Ultrasound
    1) find out the location of stone
    2) Fasting
    3) Take the blood pressure
    4) Check the cardiac physical exam
    5) Pre-medication (pain relief)
    6) Check LMP for female patients
    7) Brief the details of the treatment to the patient
    Lie the patient on the table (Supine
    oblique or prone(
    1) Compare with the previous KUB image
    2) Using, iliac crest and the spine as landmark
    3) Move the patient in the mid level of the
    removable broad

    KUB : Kidneys, ureters, and bladder x-ray


    4)Remove the broad
    5)Apply gel to the coupling cushion
    6)Move the coupling cushion to treatment
    position
    7) Increase the coupling pressure and touch
    the patient skin
    8) Apply soft pad or sand bag on the
    opposite side of the
    patient (immobilize the patient)
    10)Screening in PA view
    11)Move the table to locate the stone in the center
    12)Screening in CC view
    13)Adjust the height of the table to
    locate the stone in center
    14) Instruct to the patient
    15) Call doctor to confirm the position and
    start the treatment
    Select the suitable parameters
    1)Power of shockwave (start from low energy
    level to high energy level)
    2)The frequency of shockwave (ECG gated for
    patients with cardiac pacemakers or those with
    arrhythmias who regularly take anti-arrythmic
    drugs
    3) Total energy of shockwave (Renal
    stone < Ureteric stone(
    High energy level + high frequency = shorter treatment time

    Low energy level + low frequency =longer treatment time


    Monitor the patient condition
    e.g.Blood pressure,heart rate,pain
    Any abnormality => Stop shock wave!

    Monitor the position and the progress of


    stone
    Move far away from the center => Stop
    shock wave and make adjustment!
    Before ESWL After ESWL
    Patient is being observed for at least an
    hour in Day ward.
    Follow up 2 weeks later with X-ray (KUB)
    Remaining Stone => ESWL again
    Other treatment
    Hematomas The higher the total
    Risk of hemorrhage energy, the higher risk

    Hyperventilation tetany
    Blockage of urinary tract
    Advantages Disadvantages

    Non-invasive May require repeat


    Safe procedures
    No General anesthesia Not suitable for all types
    Short treatment time of stones
    Convenience Cause complications
    Painful
    1) Presentation powerpoint by Beatrice Pang and Connie Li,2011
    2) Dornier Medtech.Operating Manual of Dornier Gemini.2012
    3) JS Rodman et al.No more kidney stones.2007
    4) SWH Chan et al.A report on randomly sampled questionnaire survey
    about renal stone disease in Hong Kong.HK Med J.2008
    5) B Sturtevant et al. Fracture mechanics model of stone comminution in
    ESWL and implications for tissue damage.Phys Med Biol.2000
    6) W Eisenmenger.The mechanisms of stone fragmentation in ESWL.
    Ultrasound in Med.& Biol.2001
    7) http://zh.wikipedia.org/w/index.php?title=Image:KUB_stone.j
    pg&variant=zh-tw
    8) http://www.medison.ru/uzi/img/p287.jpg
    9) http://www.mwstone.com/STONES/equipment.htm
    10) http://www.tms-uro.com/eng/physicians/swl/1a_vision_device.htm
    11) http://www.dornier.com/EMEA/clinical-
    solutions/urology/kidney-stones/
    12) http://emedicine.medscape.com/article/444554-overview

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