Clinical Protocol
Whilst excellent outcomes are our prime objective, safety and the avoidance of inappropriate treatment must remain the principle aim. A balance must also be achieved between satisfactory patient co-operation and suitable analgesic cover. It is with these issues in mind that we recommend the following protocol:
Essential Documentation:
- The patient must present with, if not previously forwarded, a specific referral document.
- A Patient consent document should be completed prior to treatment.
- Medical imaging records are required. In some cases a plain-film KUB may be indicated immediately prior to treatment. Ultrasound and/or fluoroscopic localisation will be used during treatment.
- Recommended Analgesia for ESWL: Dilofenac 100mg PR minimally
Outcomes can often be improved with the administration of Pethidine 50mg - 100mg IM.Post ESWL analgesic and antibiotic cover should be considered. Appropriate pharmacy documentation must be complete. A responsible adult must accompany patients receiving pethidine.
Absolute Contraindications:
Pregnancy
Relative Contraindications:
- Anticoagulant therapy - eg Warfarin, Heparin, Clopidogrel. (Pharmacologists have confirmed that the effect of Aspirin is not dose dependent. Many Urologists elect to suspend intake for three days prior and two days following ESWL).
- The presence of other clotting impairment. Pacemaker - Whilst most modern pacemakers are approved for ESWL, cardiological clarification should be sought. Abdominal aortic aneurysm or extensive vascular calcification within 4cm axially of the treatment site.
- The presence of a urinary tract infection.
- Outlet obstruction or stricture distal to the stone.
Hospital Discharge:
The patient will be discharged when they been able to pass urine. In the unlikely event of very heavy haematuria, discharge may delayed until some dilution can be proven.
Follow up information for the Patient:
The need for increased hydration and exercise is explained in our patient information sheet.
