The urinary tract system: consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back.

The role of the kidneys is to:

•Help control blood pressure

•Help make red blood cells

•Remove extra water and wastes from the blood (wastes come from the normal breakdown of active muscle and from the food that you eat) Convert the extra water and wastes from the blood to urine

If your kidneys do not remove these wastes, they will build up in the blood and damage your body

Kidney stones are one of the most common disorders of the urinary tract.

They develop when crystals in the urine clump together instead of passing through the body. The exact cause is unknown, but risk factors include diet, urinary tract infections, and metabolic disorders.

In most cases, they pass without treatment; however, procedures such as extracorporeal shock wave lithotripsy can be used to remove problem stones.

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What's cause kidney stone:

-dehydration

-sodium intake-Excess

-urinary tract infection -

:Types of Kidney Stones

calcium oxalate

Calcium phosphateUric AcidStruvite

Cystine

Kidney stone symptomwhen kidney stones move through the

urinary tract they may causes :

-Severe pain in the backAbdomen , or groin-Frequent or painful urination-Blood in the urineFever / chills-

-Nausea and vomiting

Diagnosis:

physician will ask question about your pain

UrinalysisX ray studies:

CT abdomen/ pelvisKUB

Kidney Stones Treatment

ESWL : Extracorporeal shock wave lithotripsy UreteroscopyPCNL nephrolithotomy

Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney

StonesExtracorporeal shock wave lithotripsy (ESWL) uses shock waves to break a kidney stone into

small pieces that can more easily travel through the urinary tract and pass from the body. ESWL is only one method used to break up

kidney stones, but it is the most commonly used method because it does not require surgery

ESWL may be used on people with a kidney stone that is causing pain or blocking the urine flow.

Stones that are between 4 mm (0.16 in.) and 2 cm (0.8 in.) in diameter are most likely to be

treated with ESWL.Penetrating the body without damaging tissue

ESWL can be used to treat both stones in the kidney and stones in the ureter. ESWL may not

be as effective in patients who are obese because the increased body tissue can make it

more difficult to visualize or treat stones. -

Procedure Patient lie on a water-filled cushion, and the radiologist uses X-rays or ultrasound tests to precisely locate the stone. High-energy sound

waves pass through your body without injuring it and break the stone into small pieces. These

small pieces move through the urinary tract and out of the body more easily than a large

stone. The process takes about an hour.You may receive sedatives or local anesthesia.

Preparing for Extracorporeal Shock Wave Lithotripsy

. One week before the ESWL, do not take aspirin, aspirin-containing medicines

-urine culture: It is very important that your last urine culture was negative prior to having this

procedure. Please call the physician’s office at least one week before this procedure to confirm your urine culture results. If you suspect that you may

have a urinary tract infection, please call the physician office immediately so that proper antibiotics can be prescribed before ESWL

Do not stop any medication without contacting the

prescribing doctor to get their approval

. The Day before your ESWL:

-you should avoid all foods that cause gas

-Drink only clear liquids after lunch until midnight

_At 2:00 pm, drink (laxative) Be sure clear the bowel

.Day of ESWL

-Diabetics: skip morning meds especially insulin

- Do not eat or drink breakfast-Arrive 60 minutes before procedure

-If you take medication daily for high blood pressure or other medical conditions, take them with only a small sip of water

-

Prior to Treatment:

-place patient in a way that the stone is roughly above the center of the patient foil e.g. for a right

kidney stone the patient should be place rather on the left side of the

table.

2-the legs should be lifted up by means of the adjustable foot section .this will significantly

improve the coupling to the shock wave source (less air bubbles

between patient skin and patient foil ).

3-put water as a coupling medium between patient and patient

foil .check from below the table for air bubbles .if you see air bubbles,

wipe them out.

4_apply plenty of silicon oil 100 to the coupling

.cushions to allow proper coupling5-if stone in kidney or upper urter ,

patient supine position if stone in lower urter patient prone position

Treatment recommendations

Kidney:

Maximum: 4000 pulses---energy level 5.0*

3000 pluses------energy level 6.0*

Ureter:

Maximum: 4000 pulses_____energy level 7.0*

3000pluses ______energy level 8.0*

***During the treatment the stone should be frequently monitored by ultra sound or x-ray .check stone

position every 500-800 shocks or as soon as you recognize movement of

the patient.

***the treatment can be stopped as soon as the stone is no longer visible or

noticeably disintegrated .

***Maximum values that are not necessary for every treatment. The number of applied shock

waves and the selected energy level should be guided by

medical considerations and the tolerance of the patient.

After the treatment:

1-swivel therapy head out.

2-use a towel to soak up the water between patient and patient foil.

3-leave the silicon oil on the cushion if further treatments are planned .apply a small

additional amount of silicon oil before treating the next patient.

4-set shock wave counter back to zero (“reset” function in menu).

5_if the lithotripter will not be used for a while, please remove the silicon oil completely from the

cushion and the patient foil. Silicon oil tends to absorb dust and dirt

.After the ESWL:

-Rest. No lifting or exercise for 24 hours -Drink plenty of water or dilute juice

-Expect some passed stone fragments, -You may gave flank or abdominal discomfort-There may be occasional blood tinge in urine

Your follow-up visit will be 2-4 weeks after your ESWL. You will have an x-ray and if you

have a stent in place, it may be taken out

Go to the hospital if you have:

-Fever, chills, nausea, vomiting -Back pain, shoulder pain, or pain medication not effective -Difficulty urinating or painful urination

- Blood or clots in the urine

ESWL is usually not used if you:Are pregnant. The sound waves and X-

rays may be harmful to the fetus.Have a bleeding disorder.

Have a kidney infection, urinary tract infection, or kidney cancer.

Have kidneys with abnormal structure or function

ESWL does not successfully treat cystine kidney stones. These stones do not

break up easily.ESWL is a safe procedure and may be used on children and on individuals with only one working kidney. ESWL should not be used if you have a pacemaker unless a cardiologist has determined it is safe

COMPLICATION ESWL?ESWL has few complications. Complications

may include:Pain caused by the passage of stone

fragments. This is the most common side effect.

Blocked urine flow as a result of stone fragments becoming stuck in the urinary tract. The fragments may then need to be removed

with a ureteroscope.Urinary tract infection.

Bleeding around the outside of the kidney.

Side-effectsThese are the unwanted but mostly temporary effects of a successful treatment.

Side-effects of lithotripsy include:-pain and discomfort

-some blood and fragments of stone in urine for two or three days

-bruising or blistering of the skin of your tummy or groin