Lithotrypsy

Lithotrypsy; definition; ESWL; extracorporeal shock wave lithotrypsy; ultrasound; treatment; complications;advantages; disadvantages;

2. LITHOTRIPSY:
LITHO - Stone
TRIPSY- To Break/Crush

3. Kidney stones originate as a small grain in the kidney or upper
urinary tract and gradually grow larger as compounds in the
urine chemically attach to the stone.
Statistics show that kidney stone disease can affect as much
as two to three percent of the adult population. Nevertheless,
what causes kidney stone formation is not clearly understood.
In the past, surgery or drug therapies were the treatments for
kidney stones. Today urologists can offer alternatives such as
lithotripsy.

4. 1)First described by Christian Chaussy in 1982
2)Now the treatment of choice for the majority of renal and ureteric stones
3)Performed on a day case or outpatient basis
Minimal complication rate
4)High success rates, though repeat procedures usually necessary

6. Lithotripsy is a Greek word meaning ‘’stone crusher’’
which precisely describes the technique. Externally
generated shock waves harmlessly penetrate body
tissues, but provide enough pressure on a kidney
stone to disintegrate it into smaller granules. These
granules are small enough to be passed with urine.

7. 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

8. ESWL procedures ESWL procedures
1)Lie the patient on the table.
2)Using LCM, iliac crest and the spine as landmark
3) Move the patient in the mid level of the removable broad Procedures.
4) Remove the broad.
5) Screening in PA view.
6) Apply gel to the coupling cushion.
7) Move the coupling cushion to treatment position.
8) Increase the coupling pressure and touch the patient skin.
9) Apply soft pad or sand bag on the opposite side of the patient.
10) Screening in PA view.
11) Move the table to locate the stone in the center.
12) Screening in CC View procedures .
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

9. 1) A shockwave generator
2) A focusing system
3) A coupling system
4) An imaging/localization units

10. Sometimes the doctor will prescribe a sedative
to relax the patient.
They will be put on the lithotripsy table and an
x-ray will be taken to see where the stone is.
Then, the lithotripsy machine will be put
against the side of the body close to the stone.
The doctor will send sound waves through the
body to crush the stones. This does not hurt.
 A tapping sound can be heard as the stones
break.

12. 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)
Low energy level + low frequency =longer treatment time
High energy level + high frequency = shorter treatment time

13. 1)Hematomas *The higher the total energy, the higher risk
2) Risk of hemorrhage

3) Hyperventilation Tetany

4)Blockage of urinary tract

14. 1) No lengthy hospital stays
2) No incisions
3) No surgery

4) No lengthy recovery periods.
5) Non-invasive

6) Safe

7) No General anaesthesia

8) Short treatment

9) Time Convenience

15. 1)Some discomfort.
2)Medicine to prevent infection.
3)Passing sand-like particles in the urine for a few
weeks after the lithotripsy.
4)May require repeat procedures
5) Not suitable for all types of stones
6) Cause complications
7) Painful

16. Almost everyone can have
lithotripsy. However, there
are a few exceptions:
People who weigh more
than 300 pounds
Are pregnant
Have bleeding problems
Have non-working kidneys
Have pacemakers
People who cannot have
anesthesia or x-rays.

17. From- Tarun Chauhan
Group No.- 1115
Physics Project work