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Sunday, 10 January 2016

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Pain free and non invasive

Kidney stones, the accumulation of dissolved minerals on the inner lining of the kidneys that sometimes grow to the size of a golf ball, can lead to many conditions including severe pain and ureter (the tube connecting the kidney and bladder) blockage. Treatment is primarily focused on symptom management; passing a stone can be very painful. In some cases, urologists perform shock wave therapy called lithotripsy - a non-invasive treatment that breaks the kidney stone into smaller pieces through a process of shock waves and allow it to pass.

The Dr. Neville Fernando Teaching Hospital (NFTH), Malabe, recently launched the latest Extracorporeal Shock Wave Lithotripter (ESWL) treatment, fulfilling a 10-year promise to have a new and improved external kidney stone crushing machine in Colombo and making lithotripsy treatment more accessible to Sri Lankans.

Here, Prof Neville D. Perera, Senior Urological Consultant of the National Hospital of Sri Lanka and NFTH, Dr Neville Fernando Teaching Hospital talks about the new ESWL treatment, a procedure not freely available to the Sri Lankan private healthcare sector for a long time, and how it could benefit long suffering patients waitlisted for long periods until one of the two machines available in government hospitals are free.

Q:How does Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones work?

A: Extracorporeal Shock Wave Lithotripsy (ESWL) uses shock waves (high energy sound waves) to break kidney stones into small pieces that can be easily flushed through the urinary tract. Originated in Germany in the 1980s, it became an instant top choice due to its non invasiveness compared to other stone treatment methods (like open operations and endoscopic treatment, which carry operative risks such as bleeding, infection organ injury, longer recovery period and mostly the risks of general anesthesia).

The shock waves of older ESWL machines were more painful and sometimes needed anesthesia, this new generation ESWL machine has a High Fragmentation Shock Head and uses Electro-magnetic shock wave generator, which makes the procedure relatively pain free.

The new ESWL machine offers the highest stone free rate in the world (85 -90% stone free rate). The therapy Shock Head is the core component of any lithotripter.

The Exclusive 'High Fragmentation Shock Head' of this new technology - breaks the hardest of stones with minimum side effects.

This new ESWL machine has managed to break kidney stones which other machines have failed to break. ESWL is a safe procedure and may be used even on children. Even individuals with only one working kidney can be treated with this ESWL machine.

Q: What exactly happens during the procedure?

A: The patient rests face up on a soft cushioned table and the operator uses X-rays or ultrasound in the machine to precisely locate the stone. A small rubber balloon filled with water will be touching the loin or kidney area through which high-energy sound waves pass without injuring any soft tissues and crack the Kidney Stone into tiny pieces. Only very rarely you does one require a sedative.

Q:What should one expect after the treatment?

A: ESWL is usually an outpatient procedure. The patient goes home after the treatment, the whole process of which takes about an hour.

The patient is kept for observation for a few hours discharged with some pain killers (for occasional pain caused during the passage of stone fragments) and if necessary antibiotics. After ESWL, the patient is asked to drink 2-3 liters of water a day to flush the stone fragments. During next few days he or she will pass the small pieces while urinating with or without seeing or feeling them passing out. The urine may be slightly red coloured, but it will clear up within a few days.

Q: Who should avoid ESWL treatment?

A: Those who are pregnant, have abnormal bleeding disorders, suffering from kidney infection, urinary tract infection, or kidney cancer.

Those with abnormal or poor functioning kidneys and those on Pacemakers, unless a cardiologist has determined it is safe.

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