Thursday, May 26, 2016

Health Care and Lithotripsy

When a kidney stone gets too big to pass in the urinary tract system, trying to migrate from the kidney to the bladder, your doctor or urologist may suggest a procedure known as a lithotripsy. Surgery was the only method to remove stones too large to pass until lithotripsy was developed and replaced it as the most frequent treatment beginning in the 1980s.

The introduction of lithotripsy in the early 1980s revolutionized the treatment of patients with kidney stone disease, according to Johns Hopkins Medicine. Patients who once required major surgery to remove their stones could be treated with lithotripsy, and not even require an incision. As such, lithotripsy is the only non-invasive treatment for kidney stones, meaning no incision or internal telescopic device is required. More information is available at this website: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/lithotripsy_92,p07720/ .

Kidney stones occur when minerals and other substances in the blood crystallize in the kidneys, forming solid masses (stones). Stones may consist of small, sharp-edged crystals, or smoother, heavier formations that resemble polished river rocks. They usually exit the body naturally during urination, according to Healthline.

However, sometimes the body can’t pass larger formations through urination. This can lead to kidney damage. People with kidney stones may experience bleeding, severe pain, or urinary tract infections. When stones begin to cause these types of problems, your doctor may suggest lithotripsy. More info about lithotripsy is located at this site: http://www.healthline.com/health/lithotripsy#Overview1 .

According to the National Kidney Foundation, extracorporeal shock wave lithotripsy (ESWL) is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass more easily from the body along with the urine.

There are two ways to remove stones using shock wave treatment. In one method, the patient is placed in a tub of lukewarm water. Using x-rays or ultrasound to pinpoint the location of the stones, the body is positioned so that the stones are targeted precisely. In the second, more common method, the patient lies on top of a soft cushion or membrane through which the waves pass. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes. Much more detail about this process is located at this website: https://www.kidney.org/atoz/content/lithotripsy .

ESWL is usually an outpatient procedure, according to Healthwise. You go home after the treatment and do not have to spend a night in the hospital. After ESWL, stone fragments usually pass in the urine for a few days and cause mild pain. If you have a larger stone, you may need more ESWL or other treatments. ESWL may be used on a person who has a kidney stone that is causing pain or blocking the flow of urine.

Stones that are between 4 mm (0.16 in.) and 2 cm (0.8 in.) in diameter are most likely to be treated with ESWL. ESWL may work best for kidney stones in the kidney or in the part of the ureter close to the kidney. Your surgeon may try to push the stone back into the kidney with a small instrument (ureteroscope) and then use ESWL. More info is available at this site: http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones .

As with any medical procedure, there are always inherent risks to patients. According to the American Urological Association, although manifestations of chronic injury have been identified, it seems likely that the full spectrum of long-term injury—the form and severity of chronic adverse effects—has yet to be determined. It is intuitive that chronic effects derive from acute tissue damage, but very little is known about the progression of tissue changes that link the two.

There is also limited information about treatment dose and the development of chronic effects and whether specific risk factors exist that predispose an individual to long-term effects. Much more clinical data and research is available at this site: https://www.auanet.org/education/guidelines/shock-wave-lithotripsy.cfm .

According to the University of Florida Medical Center, here are some post surgery symptoms you may experience after going through lithotripsy:

·         Flank Pain: Most patients experience some degree of discomfort for a day or two after ESWL. The pain is usually described as a dull ache or soreness over the kidney or flank area, and is typically at its worst the evening following surgery. The pain lessens over the following days.

·         Blood in Urine: It is normal to see visible blood in the urine for days to several weeks after surgery. It is important during this time of bleeding that you avoid strenuous activity, blood thinning medications, and drink plenty of fluid.

·         Fevers: Low grade fevers are not uncommon following any surgical procedure and anesthesia. If you have fevers >101o F, please notify your surgeon and ask to be connected to the urologist on call.

There are some patients who are not suited to undergo lithotripsy. Patients who are pregnant, have active urinary infection, obstruction of the kidney or are on blood thinning medications that cannot be discontinued are not ideal candidates for ESWL treatment. Patients with particular known stone composition including cystine and certain types of calcium phosphate stones are not ideal candidates as these stone types may not fragment well with ESWL due to their dense nature. Much more detailed material is available at this website: http://urology.ufl.edu/patient-care/stone-disease/procedures/extracorporeal-shock-wave-lithotripsy-eswl/ .

If your child needs this procedure, follow the directions of your child’s doctor and nurse for caring for your child at home after the treatment. According to AboutKidsHealth, they will usually instruct that your child:
·         Drink plenty of fluids, especially water.
·         Change their diet, if needed.
·         Take medication to manage pain and nausea.
·         Get plenty of rest.

If your child is toilet trained, your child’s doctor or nurse may also instruct you to strain your child’s urine for several days and will explain how to do this. Straining the urine will enable you to collect any stone particles so that they can be analyzed in a laboratory. Your child’s doctor will use the information about the make-up of the stone to monitor your child and make recommendations (such as changes in diet) to prevent the kidney stones from recurring. A lot of additional material on this healthcare subject is located at this site: http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/Procedures/Pages/shock-wave-lithotripsy.aspx .

Kidney stones are very painful, and those that don’t pass easily are even worse. As one option for treatment, lithotripsy has its merits in spite of the associated risks. However, if your family has a history of kidney stones, you may possibly encounter this situation at some point. Educate yourself on how to deal with the medical options, the procedure, and its outcome.


Until next time.

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