www.bahrainthismonth.com November 2013 175 Shock Wave Treatment Urinary tract stones affect millions of people every year. We speak to an expert about a non-invasive method of treatment. BAHRAIN SPECIALIST HOSPITAL “Extracorporeal shock wave lithotripsy (ESWL) uses sound waves or shock waves to break urinary stones into small fragments that can pass spontaneously. It is performed usually as an outpatient procedure whilst awake or sometimes with sedation,” explains Dr Ziad M Albaha, specialist of urology at Bahrain Specialist Hospital. In most cases, there is a stone present within the kidney or upper part of the ureter that will not pass by itself. The stone may cause pain or impede the passage of urine from the kidney down to the bladder. There are several reasons to opt for ESWL over other treatments for stones. The outpatient procedure takes one hour. It is reasonably successful. There is no cutting or invasion of the body at all. Low risk of infection is also an advantage. However, ESWL may not be possible for patients with severe skeletal deformities, obesity, abdominal aortic aneurysms, uncontrollable bleeding disorders, pregnancy, cardiac pacemakers; and for some professionals and other workers who need complete and immediate stone clearance, like pilots or divers. “There are few things you need to take into consideration before your procedure,” the doctor says. “Eat a light breakfast or lunch before the procedure. If you take regular medicines, ask your doctor if they are safe to take before the procedure. For instance, you may be asked to stop taking blood thinners several days before.” Someone should be available to drive you home in case you have received medication that has made you feel drowsy or if you have pain afterwards. How is ESWL performed? While lying on the treatment table, the stone will be located either by X-ray or ultrasound. It is important to stay as still as possible during this time so that the shock waves can be accurately focused on the stone. “Ultrasound jelly is applied to the skin. Then a cushion containing water is positioned to allow the shock waves to be delivered to the stone,” Dr Ziad explains. “The treatment usually lasts between 20 and 40 minutes. You will hear a ‘clicking’ noise and feel something like a flicking on your back or front. It feels a bit like a small electric shock. If you feel uncomfortable, additional pain killers can be given.” At the end of procedure and after passing urine, it is possible to go home. Have large volumes of water to increase urine flow and help flush stone fragments through. You should be able to resume normal activities the day after treatment. It is common to see blood in your urine after the treatment, unless the urine is completely opaque. Small fragments of stone may pass, giving pain. Contact a doctor if you have a fever, if you find it difficult to pass urine or have severe pain in the back or surrounding area. “Often only one treatment is required, but large stones in difficult locations may require multiple treatments over weekly or more intervals. ESWL is very safe and has little and mild side effects,” the doctor adds. E Call 17 812-000. Dr Ziad M Albaha
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