Extracorporeal Shock Wave Lithotripsy

Summary

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive medical procedure used to break down kidney stones that are too large to pass on their own. This technique employs shock waves generated outside the body, which are focused on the stone to fragment it into smaller, passable pieces. Usually conducted with the use of a stent to prevent obstruction from large stone fragments, this procedure requires the patient to be under anesthetic due to its painful nature. The process involves real-time x-ray imaging to position and break the stone effectively using equipment that resembles a large spark plug and parabolic dish to focus the shock waves accurately.

Highlights

• Extracorporeal Shock Wave Lithotripsy targets large urinary stones.🪨
• Stents are sometimes required to avoid stone fragment blockage.🔄
• Shock waves focus energy to fragment the stone into passable pieces.💥
• X-ray imaging is crucial for precise targeting of stones.📽️
• Patients require anesthetic due to procedure pain.💉

Key Takeaways

• Lithotripsy is used for large stones in the urinary tract, typically measuring more than half an inch.🪨
• A stent may be used during the procedure to prevent blockage by stone fragments.🔄
• Shock waves are focused on the stone to break it down, making them passable.💥
• Real-time x-ray imaging helps accurately position the stone for treatment.📽️
• Anesthesia is required due to the pain associated with the shock waves.💉

Overview

Extracorporeal Shock Wave Lithotripsy is a cutting-edge procedure designed to tackle large and painful kidney stones from outside the body. Utilizing advanced technology, it focuses shock waves directly onto the stone, breaking it into smaller, easier-to-pass fragments, all while minimizing invasive measures.

A crucial part of the procedure is the use of real-time x-ray imaging, or fluoroscopy, which ensures precision by accurately aligning the shock waves with the stone. This careful targeting is essential, as the shock waves are powerful enough to break stones but need to be concentrated correctly to avoid unnecessary damage.

Patients typically undergo this treatment under anesthesia, given the potential discomfort from the shock waves. The use of a stent might be necessary to prevent any fragments from causing blockages post-procedure. Combining modern imaging techniques with carefully controlled shock wave technology, ESWL represents a significant advance in non-invasive stone treatment.

Chapters

• 00:00 - 00:30: Introduction to Extracorporeal Shock Wave Lithotripsy The chapter introduces Extracorporeal Shock Wave Lithotripsy, a procedure for treating stubborn stones located high in the urinary tract. These stones are typically too large to pass naturally or cause significant pain when passing. The chapter includes an introduction to the technology used to break up the stones and presents x-ray imagery of the stones to be addressed in the procedure.
• 00:30 - 01:00: X-ray Interpretation and Stint Placement The chapter titled "X-ray Interpretation and Stint Placement" discusses the details of placing a stint in the urinary tract as seen on an X-ray. It explains that a stint, a hollow plastic tube, is inserted to prevent obstruction of the urinary tract by large stone fragments. This process is often associated with a procedure called lithotripsy, although it is not always necessary. The X-ray shows the position of the stint from the patient's bladder, where it curls, up to the kidney, helping to maintain an unobstructed pathway.
• 01:00 - 01:30: Advantages and Disadvantages of Stints The chapter explores the use of stints in medical procedures involving large stones. It discusses the necessity of stints for stones larger than half an inch, as they offer protection against blockages caused by stone fragments. However, the use of stints is not without drawbacks, as patients may experience discomfort post-operatively, including sensations of poking in the bladder area and pain during urination.
• 01:30 - 02:30: Procedure of Shock Wave Lithotripsy The chapter details the procedure of Shock Wave Lithotripsy, specifically targeting a stone in the lower part of the right kidney. It describes how shock waves are generated outside the body and are focused onto the kidney stone, passing through the skin. The method involves pinpoint accuracy, with the shock wave converging at the level of the stone, helping to break it down into smaller, passable pieces.
• 02:30 - 03:30: Real-Time Imaging and Shock Wave Generation The chapter discusses the process of using real-time x-ray imaging, known as fluoroscopy, to focus energy on a stone within the body. The patient is positioned on a movable table, allowing for precise adjustments in three dimensions to ensure that the energy is concentrated accurately on the stone's location. The use of fluoroscopy facilitates the centering of crosshairs on the stone for effective shock wave treatment.
• 03:30 - 04:30: Functioning of Shock Wave Equipment The chapter discusses the setup and functioning of shock wave equipment used for treating kidney stones. The process involves positioning the stone correctly and then generating shock waves at a rate of 120 per minute. Because the procedure is painful, patients require anesthetic, typically a spinal anesthetic, as noted in this particular case.

Extracorporeal Shock Wave Lithotripsy Transcription

• 00:00 - 00:30 today we're going to be doing a procedure called extracorporal Shockwave lithotripsy uh it is a procedure used for stones that are located high in the urinary tract um these stones are generally too big to pass or causing a great deal of pain and trying to pass and we will then use the technology that I'll explain a little bit later to break the stones up I first want to show you the stones that we're going to be taking care of today this is an x-ray of the procedure of the patient that we're going to be doing today um this is the
• 00:30 - 01:00 spine this is the patient's right the patient's left this is a stin which had been previously placed a stin is a hollow plastic tube which goes from the bladder which you can see the curl down here in the bladder all the way up and this continues up to the kidney a stint is used to prevent the urinary tract from being obstructed by large Stone fragments sometimes a stin is necessary uh during a lithotripsy as we call this procedure sometimes it is not generally
• 01:00 - 01:30 if there is a large Stone greater than about half an inch or so we will need to place a stint otherwise we can do this procedure without a stin the stin offers a measure of protection for the patient against having a stone fragment block them up however the disadvantage to exent is that it does cause some discomfort to the patient in the post-operative period um generally the patient will feel some poking in the bladder area and they will feel some pain in their side when they urinate
• 01:30 - 02:00 while they have a stint in we are going to start treating this Stone in the lower part of the right kidney by using extracorporal Shockwave lithotripsy Shockwave lithotripsy creates shock waves outside of the body that are focused onto the stone as they come through the skin the the shock wave is coming through a pattern about this big as it approaches the level of the stone
• 02:00 - 02:30 it is focused down in a cone where all of the energy is focused directly at the stone the patient is laying on a table that moves um up and down back and forth and then we adjust it in three dimensions to where the very tip of that cone is centered on the stone what we see here using real time x-ray Imaging called fluoroscopy we are centering the crosshairs on the Stone in
• 02:30 - 03:00 the lower part of the kidney and once we're satisfied that we have everything set up um with the stone in the proper position we will then begin creating the shock waves uh these will be generated at about 120 a minute and that's the popping that you can hear right now this is painful for patients if they are awake so they do need some form of anesthetic uh generally we use a spinal anesthetic which this patient has
• 03:00 - 03:30 chosen this piece of the equipment is the fluoroscopy unit that's what's generating the x-rays and transferring it to the screen where we can monitor it throughout the procedure here the shock waves are actually generated in this part of the the equipment this is located directly under the stone and then then we move the patient up and down to get the stone at the tip of that cone as I had mentioned the shock wave is generated by having basically a the
• 03:30 - 04:00 easiest way to think of it is a giant spark plug underwater and as a great amount of power is transferred from one side of the spark plug to the other it creates a um huge gas bubble where there's a rapid expansion of the water into gas which happens whenever you heat water that is transferred out in all directions but it's caught by a parabolic dish under it kind of like a satellite dish that then Focus fuses
• 04:00 - 04:30 that shock wave back up towards the stone and that stone then that shock wave then breaks the stone up into fragments