lithotrity
lithotripsy
[lith´o-trip″se]For kidney stones, ESWL shatters the calculi into particles small enough to be passed in the urine. The procedure takes no longer than one to two hours, permits a shorter hospital stay, and allows the patient to return to normal life without delay.
ESWL is not appropriate for every patient with kidney stones. Body structure may prohibit proper positioning in the tank of water in which the patient must be submerged. Other contraindications include calcium deposits in the arteries, obstruction to urine flow, which is depended upon to flush out the fragments, and exaggerated spinal curvature, which interferes with visualization on x-ray. Stones that are not radiopaque cannot be treated by ESWL unless a radiopaque contrast medium is used because otherwise they cannot be seen and the shock waves cannot be properly focused on them. Very large stones (over one and a quarter inches in diameter) are not amenable to ESWL because they require more energy than the equipment can generate to break them into pieces small enough to travel through the urinary tract.
Complications such as obstruction to urine flow, bleeding, infection, and pain are less for ESWL than for other modes of therapy. The most formidable obstacle to widespread use of ESWL is the cost of the equipment.
For treatment of gallstones, the lithotriptor is used in combination with an ultrasound probe. The probe locates the calculi and the lithotriptor is fired. The fragments of gallstone traverse the biliary tract and are excreted via the intestines.
Advantages of PUL over conventional surgical procedures for removal of kidney stones are fewer complications, a surgical incision less than 1 to 2 cm long as compared to one 20 cm long, shorter hospital stay, and more rapid recovery.
After surgery the vital signs are monitored to detect evidence of bleeding or infection. Some bright red blood in the urine passing through the nephrostomy can be expected for one to three days, but the amount of blood should gradually diminish. As bleeding subsides the urine becomes smoky and tinged with old blood. The kidney is a highly vascular organ and postoperative hemorrhage is always a threat.
If the patient has either a Foley catheter or a ureteral catheter or both remaining in place after surgery, they must be kept open and draining. Irrigations, if ordered, are done gently to avoid excessive bleeding. A decrease in drainage and flank pain may indicate obstruction in the urinary tract. Other complications to be watched for include retroperitoneal bleeding, infection, delayed allergic reaction, and pneumothorax or hemothorax.
If the patient goes home with the catheter in place, instruction in self-care is necessary. The patient and family will need to know how to care for the incision site and the urine collection device. They should be taught how to note and record urine volume and evaluate its color and to report to the physician any leakage of urine from the incision site that persists after four days. They also will need to report any symptoms of infection, development of pain, or bright red hematuria. The importance of taking antibiotics precisely as prescribed is stressed. Antibiotic therapy is usually continued for two weeks after surgery. If no complications develop, the patient is able to return to normal daily activities within a week after drainage stops.
lith·o·trip·sy
(lith'ō-trip'sē),lithotrity
(lĭ-thŏt′rĭ-tē)lith·o·trip·sy
(lith'ō-trip-sē)Synonym(s): lithotrity.