Lithotripsy is the procedure used for treating some types of kidney stones and stones in other organs, such as the gallbladder or liver. Kidney stones take form as minerals and other substances in the urine crystalize in your kidney. Kidney stones are usually solid masses, or stones, which consist of small, sharp-edged crystals or smoother, heavier formations that resemble polished river rocks. They usually exit your body naturally during urination.
Although normally the kidney stones pass naturally during urination, sometimes the body can’t pass the larger formations. Those with kidney stones may experience bleeding, severe pain, or urinary tract infections. When you are having such problems with your stones, you may be suggested lithotripsy by your doctor. Lithotripsy is done on an outpatient basis, meaning you’ll leave the hospital on the same day of your procedure. You’ll lie on an exam table, on top of a soft, water-filled cushion for the procedure to be performed. You’ll also be given medicine to sedate and antibiotics to fight infection. For the procedure, high-energy shock waves will pass through your body till they reach the kidney stones. These waves will break the stones into very small pieces which can be easily passed through your urinary system. You’ll stay in recovery for about 2 hours before being sent home. Make sure to cancel any plans so you’ll get full rest at home the following couple of days from the procedure. Also, don’t forget to drink plenty of water for several weeks after lithotripsy. By doing so, you make sure to flush out any remaining stone fragments.
Lithotripsy is a non-invasive medical procedure used to treat kidney stones that are too large to pass through the urinary tract. The term “lithotripsy” is derived from the Greek words “litho,” meaning stone, and “tripsy,” meaning crushed.
The procedure works by sending focused ultrasonic energy or shock waves directly to the stone. These shock waves are generated by a machine called a lithotripter. The shock waves travel into the body, through skin and tissue, reaching the stone where they break it into small fragments. For several weeks following treatment, those small fragments are passed out of the body in the urine.
Lithotripsy is the only non-invasive treatment for kidney stones, meaning no incision or internal telescopic device is required. This makes it a preferred choice for many patients as it avoids the need for an invasive surgical procedure for stone removal.
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.
The main advantage of this treatment is that many patients may be treated for kidney stones without surgery. As a result, complications, hospital stays, costs and recovery time are reduced. Unfortunately, not all types of kidney stones can be treated this way. In addition, stone fragments are occasionally left in the body and additional treatments are needed.
The urinary system, also known as the excretory system, is a crucial part of the human body. It consists of several organs that work together to filter blood, remove waste products, create urine, and transport urine out of the body.
The main organs of the urinary system are the kidneys, ureters, bladder, and urethra. The kidneys, located on either side of the back of your abdomen, filter about 120 to 150 quarts of blood per day, producing about 1 to 2 quarts of urine. They separate toxins from nutrients, with vitamins, minerals, nutrients, and proteins returning back to your bloodstream. Waste products and urine move from your kidneys through your ureters to your bladder. The bladder stores the urine until you use the toilet, after which urine leaves your body through your urethra.
The urinary system plays a vital role in maintaining the body’s balance of water, electrolytes, and acid-base (pH) balance in the blood. It also helps regulate blood volume, and blood pressure, stimulates red blood cell production, and converts Vitamin D to its active form of calcitriol.
Lithotripsy is a non-invasive medical procedure used to treat kidney stones that are too large to pass through the urinary tract. It is used when the stones cause blockage, severe discomfort, pain, frequent urinary tract infections, or bleeding. Lithotripsy works by sending focused ultrasonic energy or shock waves directly to the stone, breaking it into small fragments that can pass through the urinary system.
Shock wave treatment may be used in two different ways to remove stones:
You’ll be placed in a tub of lukewarm water. X-ray or ultrasound will then be used to pinpoint the location of the stones.
The more common method; you lie on top of a soft cushion or membrane through which the waves pass. Normally around 1-2 thousand shock waves are needed to crush the stones. This treatment takes about 45-60 minutes.
Lithotripsy treatment has a brief recovery, as patients get up to walk almost at once. Most patients can resume daily activities within 1-2 days. They are required to drink plenty of water to help the stone fragments pass.
Before undergoing lithotripsy, a series of steps are taken to ensure the patient is prepared for the procedure.
Firstly, the doctor or nurse will inform the patient about any special preparations they need to make. This could include fasting for a certain period before the procedure or adjusting the intake of certain medications.
The doctor will conduct a thorough examination of the patient and may order several tests, such as lab tests or imaging tests like CT or MRI. These tests help to determine the size, number, location, and composition of kidney stones.
The patient’s health history is also taken into account. This includes any past health problems, surgeries, and current medications. The patient needs to inform the doctor about any medicines they are taking, including prescription or over-the-counter medicines, as well as any herbal supplements. This is because certain medicines can increase the risk of bleeding during the procedure.
In some cases, the patient may be instructed to avoid certain medications, such as aspirin or aspirin-like compounds, for a period before the procedure. These medications can increase the risk of bleeding.
The patient will also receive information about what to expect during and after the procedure, including potential side effects and recovery time. They will be informed about the need for someone to accompany them home after the procedure, as they may be under the effects of anesthesia.
On the day of the procedure, the patient will receive an IV for the administration of fluids and medications. Anesthesia will be administered to ensure the patient does not feel pain during the procedure.
During lithotripsy, the patient is positioned on an X-ray fluoroscopy table in the anteroposterior (AP) projection and along a 30° anterior oblique (AO) projection. The procedure begins with the administration of anesthesia to ensure the patient does not feel pain during the procedure.
A lithotripter, located outside the patient’s body, is used to generate high-energy shock waves. These shock waves are focused on the renal stones to pulverize them into small fragments that can pass via the urinary tract. The number of shock waves needed for each patient varies, with a mean of 3200 pulses reported in one study.
In some cases, complementary therapies such as acupressure at the Qiu point are used to control pain and improve patient comfort during the procedure. Ten minutes before lithotripsy, the intervention group receives acupressure at the Qiu point, while the sham group receives touch at a neutral point. The primary outcomes are pain intensity measured by the Visual Analog Scale (VAS) and physiological indices such as blood pressure and heart rate at baseline, 1, 10, 20, 30, 40, and 50 min after the intervention.
Radiation dose received by patients during the procedure is also a concern. Thermoluminescent dosimeters (TLDs) are used for radiation dose measurements. Each TLD chip is taped on the back of the patient at the entrance surfaces of the X-ray beam to evaluate the entrance surface dose (ESD). The mean ESD in the postero-anterior (PA) and oblique X-ray beam entrance were obtained at 12.04 and 68.84 mGy, respectively.
After the procedure, the patient is monitored for any complications or side effects. The patient’s vital signs are checked regularly, and pain management is provided as needed.
After undergoing lithotripsy, the patient is closely monitored to ensure their well-being and recovery. The patient can usually move about almost immediately after the procedure. Many people can fully resume daily activities within one to two days.
The patient will be advised to drink plenty of water to help the stone fragments pass through the urinary system. The remaining particles of small stones will exit the body when the person urinates1. This process can take several days or weeks.
Pain management is an important aspect of post-lithotripsy care. The patient may experience discomfort or pain as the stone fragments pass through the urinary tract. In some cases, medications may be prescribed to manage this pain.
Patients are typically scheduled for follow-up appointments to monitor their recovery and to ensure that all stone fragments have been passed. Additional tests, such as imaging studies, may be performed to confirm the successful removal of the stones.
Like most medical procedures, lithotripsy carries some risks, even when performed.
One of the primary risks associated with lithotripsy is internal bleeding. The high-energy shock waves used to break down kidney stones can potentially damage surrounding tissues and blood vessels, leading to bleeding. In some cases, this may require a blood transfusion.
Another risk is infection. Any medical procedure that involves the urinary tract can potentially introduce bacteria, leading to an infection. Antibiotics are often given before and after the procedure to minimize this risk.
Kidney damage is another potential risk of lithotripsy. If a stone fragment blocks the flow of urine out of the kidneys, it can lead to kidney damage. This is why patients need to drink plenty of water after the procedure to help pass the stone fragments.
While lithotripsy is a significant advancement in the treatment of kidney stones, it is not without risks. These include internal bleeding, infection, and kidney damage. The increasing prevalence of kidney stones and the associated risk factors highlight the importance of careful patient selection, meticulous procedure planning, and thorough post-procedure care to minimize these risks.
Equipped hospitals and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who suffer from kidney stones.
The cost of lithotripsy treatment in Iran, like in any other country, can vary depending on several factors, including the hospital, the doctor’s expertise, the patient’s health condition, and the specific requirements of the procedure.
The cost of lithotripsy treatment in Iran ranges around 1000-2000 USD, which is generally more affordable compared to many Western countries. This is due to a combination of factors, including lower living costs, government subsidies for healthcare, and the use of generic drugs.
It’s also worth noting that the cost of lithotripsy can be influenced by additional expenses such as pre-operative tests, post-operative care, and medications. Therefore, patients are advised to consider all these factors when estimating the total cost of the procedure.
Despite the lower costs, the financial burden of lithotripsy can still be significant for many patients. Therefore, patients need to discuss the cost with their healthcare provider and explore possible payment options.
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The cost of a lithotripsy procedure may vary based on the patient's specific surgical needs, surgeons' fees, way of treatment, and hospital fees.
The lithotripsy procedure takes about 45-60 minutes. You’ll be given local, regional or general anesthesia so you don’t experience pain. Afterward, stone debris will be removed from your kidneys or ureter.
Most people can resume daily activities within 1-2 days. You won’t be given a special diet but drinking plenty of water will help with the passage of stone fragments. You may experience some pain as you are passing the fragments, which begins soon after treatment and may last for up to 4-8 weeks.
Shock wave lithotripsy is often used to treat kidney stones larger than 5mm (in diameter) which can’t be passed on their own and block urine flow.
Passing of the stone pieces which may take 4-8 weeks, may cause pain and nausea.
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