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بنام خدا

بنام خدا. به نام خدا. Extracorporeal Shock-wave lithotripsy (ESWL). Epidemiology. Nephrolithiasis with a lifetime prevalence 13% in men and 7% in women 80-85%  Ca- based 20% uric acid,struvite,cystine ,……. P athophysiology. For uric acid,struvite,cystine stones are predictable

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بنام خدا

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  1. بنام خدا به نام خدا

  2. Extracorporeal Shock-wave lithotripsy(ESWL)

  3. Epidemiology Nephrolithiasis with a lifetime prevalence13% in men and 7% in women 80-85%  Ca- based 20%uric acid,struvite,cystine,……

  4. Pathophysiology For uric acid,struvite,cystine stones are predictable For calcium stone formation is multifactorial: hypercalciuria hyperoxaluria hyperuricosuria hypocitraturia dietary factors

  5. Therapeutic option ESWL Ureteroscopy PCNL Open surgery SWL has been the most commonly used approach49-54% of procedures to treat renal stones

  6. contraindications Active UTI Distal obstruction Pregnancy coagulopathy

  7. Preoperative preparation D/C of anticoagulants Documentation of a negative U/C R/O of pregnancy Bowel prep Antibiotic CBC Renal function test

  8. Not suitable for ESWL Lower pole stones Morbid obes Hounsfield unite>1000 SSD>10 cm Cystine and brushite are the most resistant to SWL Small diameter of lower pole infundibula Lower pole with multiple infundibula the angle formed between the lower infundibulum and the renal pelvis

  9. Position for SWL Supine Prone transplant kidney ectopic kidney lower ureter stones

  10. Anesthesia Prevent patient’s movement

  11. Post op Antibiotic Analgesic KUB+SONO2-4 wk after the procedure In several trrials the use of potassium citrate or tamsulosin with or without methylprednisolone has resulted in superior stone- free rates as compared with placebo For PT with stones that failed to fragment repeat SWL may be considered 2 weeks or more

  12. Stone free rate Passage of fragmens may continue for up to 3 months

  13. Adverse effects Obstruction steinstrasse(stone street)6-20% Hematoma risk factors: older age HTN DM IHD obesity

  14. Acute Extrarenal Damage Trauma to organs such as the liver and skeletal muscle, as evidenced by elevated levels of bilirubin, lactate dehydrogenase, serum aspartatetransaminase, and creatinephosphokinase within 24 hours of treatment Parameters begin to fall within 3 to 7 days of SWL treatment and Are normal at 3 months.

  15. Acute Extrarenal Damage Perforation of the colon Hepatic hematoma Splenic rupture Pancreatitis Abdominal wall abscess

  16. Acute Renal Injury Hematuria Hematoma Shockwaves rupture blood vessels and can damage surrounding renal tubules

  17. Chronic Renal Injury It is well accepted that shockwaves damage blood vessels, and the resulting hemorrhage initiates an inflammatory response that ultimately leads to scar formation. Rise in systemic blood pressure Decrease in renal function Increase in the rate of stone recurrence

  18. Factors That Induce the Degree of Renal Trauma Associated with Shockwave Lithotripsy Number of shocks Accelerating voltage Kidney size—juvenile vs. adult Preexisting renal impairment Treatment at a slow rate of shockwave delivery (60 shocks/min or less)

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