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Post-ESWL patient instructions

Post ESWL Topic
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

If you have done an ESWL procedure or you just make a decision for treatment on your kidney stone recently, I doubt this article would be benefit right to you. ESWL- an Extracorporeal Shockwave lithotripsy, is the least invasive procedure specifically on kidney stones. The world latest 4th Generation ESWL is currently installed at Royal Phnom Penh hospital. Either way, there still remains some minor side effects from the tool that you could’ve known or experienced after the completion of the procedure. (This reference’s data originated from European Association of Urology on Urolithiasis 2020.) And here they are…

Immediate postoperative’s side effects

  1. Bloody urination almost 100%
    • Regarding to the mechanism of the breaking stone were sending by the shockwave pulses right to the stone, so, stone are breaking from a blast-affect. So it is inevitably to avoid the minor kidney tissue’s injured from debris of the stone and this will leads to a bloody urination.
    • Bloody urination along with the debris will always experience after ESWL procedure
    • This symptom can be better in few days after the procedure goes by
    • You’ll be encouraging to drink water from 2 – 3 liters a day, this is rapidly improved the bloody urination condition.
Bloody urine
Bloody urination – Almost 100%
  1. Steinstresse  4 – 7 % risk
    • It is a German term or “stone route” in English
    • When stone was crashed into pieces, it will possibly dropping down to the ureter and they will accumulated through route, this mechanism apparently viewed by imaging tools.
    • Steinstresse will leads to a flank pain or asymptomatic
Stone street
Stone route-like appearance inside the ureter – 4 – 7%
  1. From 21 – 59 % at risk for residual stone’s regrowth
    • The residual stone that less than 4 mm, it’s considering as insignificant stone
    • Insignificant stone can spontaneously pass out by its own
    • 21% chances of growing of insignificant stone at 5 years needs to do the following up
    • Normally, the observation of the residual stone will regularly perform by the ultrasound only.
Regrowth stone
Regrowth Residual stone – 21 – 59%
  1. From 2 – 4 % at risk for the kidney stone pain
    • When stone breaks into pieces, sometimes it aggravated a sudden pain
    • You still encourage to drink 2 – 3 liters of water a day in order to reduce the chance of the stone pain
    • It also has an oral medication that could’ve reduced the stone pain after ESWL procedure
Flank pain
Flank pain from fragment of the kidney stone – 2 – 4%
  1. From 1 – 2.7 % at risk with a blood stream infection
    • The kidney stone is the place where the bacteria lived, once we break it down, they will run for their lives, sometimes they ran into the blood stream and made the troubleshooting in there.
    • We will never suggest the oral antibiotic after ESWL, do so, it is like giving a chance of a drug resistance by the way.
    • The best practical is to observe whether they will have a fever after ESWL procedure or not?
  2. A gigantic bleeding from kidney tissue < 1 % risk
    • Since the ESWL is considered as the least invasive kidney stone procedure, therefore, a severe injury of kidney is minimally reported.

Long term effect

There is no existing evidence supporting the hypothesis that ESWL can cause long-term complications.

No reported on long term complication
From the EAU recommendation on 2020 – No long term complications were reported.
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