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Extracorporeal Shock Wave Lithotripsy (ESWL) Pre- and Postoperative Instructions

Prior to Surgery

What to Expect during Your Preoperative Consultation

During your initial consultation with your surgeon, he or she will review your medical history, as well as any outside reports, records and X-ray films (e.g., CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for this procedure, you will then meet with a patient service surgery coordinator to arrange for the date of your procedure.

Note: It is very important that you bring all of your X-ray films and reports to the initial consultation with your surgeon.

What to Expect prior to the Surgery

Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.

For The Johns Hopkins Hospital: These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was received.

Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:

  • Physical exam
  • Electrocardiogram (EKG)
  • Complete blood count (CBC)
  • Blood coagulation profile (PT/PTT)
  • Comprehensive metabolic panel (blood chemistry profile)
  • Urinalysis

Preparation for Surgery

Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)

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 your surgery.


What to Expect after Surgery

Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)

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 your surgery.

What to Expect after Discharge from the Hospital

  • Pain control: You can expect to have some incisional discomfort that may require pain medication for a few days after discharge. Afterward, Tylenol should be sufficient to control your pain.
  • Bleeding: It is normal to see blood in the urine for several weeks after surgery.

How do I know if ESWL was successful?
Several weeks following ESWL treatment, your urologist will perform a follow-up X-ray to determine whether the stone was broken up into small pieces and if those small pieces passed out of the kidney. If the stone has broken up into small fragments but the fragments have not cleared, the X-rays may be repeated again after another several weeks.
If the stone has not broken up into small fragments, your urologist will likely recommend further treatment. In most cases, if the stone does not break up following one ESWL treatment, more ESWL treatments are unlikely to be successful. In this situation, other treatments, such as ureteroscopy or percutaneous nephrolithotomy, may be recommended.


When to Call Your Doctor

Although ESWL is a safe treatment, it is important to note that adverse events, although uncommon, do occur. You should contact your doctor if you experience:

  • Increasing pain, or pain that is getting worse instead of getting better. This may indicate either that there is bleeding around the kidney as a result of ESWL or that the kidney stone fragments have all fallen into the ureter and are blocking the drainage of urine from the kidney.
  • Large amounts of blood or blood clots in the urine, which may indicate that the kidney was injured by ESWL treatment.
  • Fever, which may indicate that there is a serious kidney infection.

Our Surgeons

Photo of Dr. Brian Richard Matlaga, M.D., M.P.H.

Matlaga, Brian Richard, M.D., M.P.H.

Professor of Urology
Director, The Stephens Center for Stone Disease
Expertise, Disease and Conditions: Benign Prostatic Hyperplasia (BPH), Endourology, Kidney Stones, Urology
 

Appointments

To make an appointment for consultation, please call 410-955-6100.

Directions to The Johns Hopkins Hospital.

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