What are the recommended post-procedure protocols after lithotripsy (extracorporeal shock wave lithotripsy)?

Post-Procedure Protocols After Extracorporeal Shock Wave Lithotripsy (ESWL)

After extracorporeal shock wave lithotripsy (ESWL), you should follow a structured post-procedure protocol that includes monitoring for complications, pain management, and follow-up imaging to ensure optimal recovery and stone clearance.

Immediate Post-Procedure Care

• Monitor for hematuria: Expect some blood in the urine (macroscopic hematuria occurs in approximately 17.2% of cases) 1

• Pain management:

  • Take prescribed pain medications as directed
  • NSAIDs like diclofenac are typically effective for post-ESWL pain 2, 3
  • Avoid combining opioids with benzodiazepines as this can cause significant drops in oxygen saturation 3

• Hydration: Maintain adequate fluid intake (2-3 liters per day) to help flush out stone fragments

• Activity: Resume light activities within 24-48 hours, but avoid strenuous activities for 1-2 weeks 4

Monitoring for Complications

• Watch for signs of infection:

  • Fever (>38°C/100.4°F)
  • Chills
  • Severe flank pain
  • Cloudy or foul-smelling urine
  • Nausea/vomiting that persists

• Be alert for steinstrasse (stone street) - occurs in approximately 4% of cases 1

  • Symptoms include persistent flank pain, inability to urinate, or severe pain with urination
  • Requires prompt medical attention

• Monitor for renal colic (occurs in 2-4% of patients) 1

  • Take prescribed pain medication
  • Apply heat to the affected area
  • Increase fluid intake
  • Contact your doctor if pain is severe or uncontrolled

Medication Protocols

• Antibiotics:

  • Not routinely recommended unless you have specific risk factors 1:
    • Positive pre-procedure urine culture
    • Indwelling nephrostomy tubes or stents
    • History of recurrent UTIs
    • Immunocompromised status

• Medical expulsive therapy (MET):

  • Alpha-blockers may be prescribed to enhance stone passage 1
  • Take as directed for the full prescribed course

Follow-up Care

• Imaging:

  • Attend scheduled follow-up imaging to assess stone clearance 1
  • Typically scheduled 2-4 weeks after procedure

• Stone collection:

  • Strain all urine to collect stone fragments for analysis
  • Use a fine mesh strainer or specialized collection device provided by your healthcare provider

• Return to normal activities:

  • Most patients can resume normal activities within 1-2 weeks after removal of all drainage tubes 4

When to Seek Immediate Medical Attention

• Severe, uncontrolled pain
• High fever (>38.5°C/101.3°F)
• Inability to urinate
• Excessive bleeding (bright red blood in urine that doesn't clear)
• Signs of infection (chills, severe pain, cloudy urine)

Long-term Follow-up

• Stone analysis: If fragments are collected, they should be analyzed to determine stone composition
• Preventive measures: Based on stone composition, specific dietary and medication recommendations may be provided
• Monitor for recurrence: Follow-up imaging may be recommended to check for residual fragments, which may regrow in 21-59% of cases 1

Remember that additional procedures may be required in 6-9% of cases 1, so maintaining follow-up appointments is crucial for ensuring complete stone clearance and preventing complications.