Extracorporeal Shock Wave Lithotripsy

Summary

This video explains the process of Extracorporeal Shockwave Lithotripsy (ESWL), a procedure used to treat large stones in the urinary tract that are difficult or painful to pass. The procedure involves generating shock waves outside the body, which are focused on the stone to break it into smaller fragments. The patient, positioned on a table, undergoes real-time x-ray monitoring to ensure the stone is correctly targeted. A spinal anesthetic is used for patient comfort as shock waves are generated and focused to break the stone. The video also discusses the use of a stent to prevent obstruction during the procedure.

Takeaways

• 😀 Extracorporeal Shockwave Lithotripsy (ESWL) is a procedure used to treat stones in the upper urinary tract that are too large or painful to pass.
• 😀 Stones in the urinary tract that are too big to pass or causing pain can be treated using shockwave technology to break them up.
• 😀 A stent is a hollow plastic tube placed between the bladder and kidney to prevent obstruction from large stone fragments.
• 😀 A stent may be necessary during ESWL if the stone is larger than half an inch to prevent stone fragments from blocking the urinary tract.
• 😀 The procedure typically uses spinal anesthesia to reduce pain for the patient, as shockwave lithotripsy can be painful if the patient is awake.
• 😀 The patient is positioned on a moving table, and the shockwaves are focused directly on the stone using real-time x-ray imaging (fluoroscopy).
• 😀 The shockwaves are generated at a rate of 120 per minute, which creates a popping sound during the procedure.
• 😀 The shockwaves are created by a powerful spark plug underwater, which generates a gas bubble that expands rapidly and produces the shockwave.
• 😀 The shockwave is focused using a parabolic dish, similar to a satellite dish, which directs the energy towards the stone to break it up into fragments.
• 😀 The procedure's success depends on accurately aligning the stone with the shockwave cone to ensure the stone is effectively fragmented.

Q & A

What is Extracorporeal Shockwave Lithotripsy (ESWL)?

Extracorporeal Shockwave Lithotripsy (ESWL) is a medical procedure used to treat kidney stones that are too large to pass or cause significant pain. It utilizes shock waves generated outside the body to break the stones into smaller fragments.

Where are the stones typically located that require ESWL treatment?

The stones that require ESWL treatment are typically located high in the urinary tract, often near the kidneys.

Why is a stent sometimes necessary during lithotripsy?

A stent is used during lithotripsy to prevent obstruction of the urinary tract by large stone fragments. It ensures the flow of urine from the kidney to the bladder and protects the tract during the procedure.

What is a stent, and where is it placed in the body?

A stent is a hollow plastic tube placed in the urinary tract, extending from the bladder to the kidney. It helps prevent obstruction due to stone fragments during and after the procedure.

What are the disadvantages of having a stent in place?

The disadvantage of having a stent is that it can cause discomfort to the patient, including pain when urinating and a feeling of poking in the bladder area.

How does the shock wave treatment work in ESWL?

In ESWL, shock waves are created outside the body and focused onto the stone using a specialized machine. The shock waves break the stone into smaller fragments by causing rapid expansion and contraction in the surrounding water, which is directed at the stone.

What role does fluoroscopy play in the ESWL procedure?

Fluoroscopy provides real-time x-ray imaging to help guide the procedure. It is used to center the shock wave energy on the stone by monitoring its position during treatment.

How are the shock waves generated for lithotripsy?

Shock waves are generated using a device that creates a rapid expansion of water into gas by transferring power from a spark plug-like device underwater. This creates a bubble that produces the shock wave, which is focused toward the stone using a parabolic dish.

What type of anesthesia is typically used for ESWL?

Spinal anesthesia is commonly used for ESWL, as the procedure can be painful if the patient is awake.

Why does the patient need to lie on a movable table during ESWL?

The patient lies on a movable table to adjust their position in three dimensions, ensuring that the stone is correctly aligned with the shock wave cone for optimal targeting.