Electocorporeal shock wave lithotripsy (eswl)
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Electocorporeal shock wave lithotripsy(eswl)
It’s a non invasive
A technique of removing kidney stones
Does not need open surgery.
Principal of lithotripsy
SHOCK WAVES GENERATED UNDER WATER CAN TRAVEL THROUGH BODY WITHOUT ANY APPRECIABLE LOSS OF ENERGY. WHEN THEY ENCOUNTER STONES THE CHANGES IN DENSITY CAUSES ENERGY TO BE ABSORBED AND REFLECTED BY THE STONE & THIS RESULTS IN FRAGMENTATION OF THE STONES.
Types of stones
Most common one is –calcium oxalate
Calcium phosphate
Uric acid stones
Struvite stones
Cystine stones
Cause of Stone Disease
Supersaturation of urine is the key to stone formation
Intermittent supersaturation - Dehydration
Crystal aggregatio
Defects in transport of Calcium and Oxalate by Renal epithelia
Calcium oxalate stones
Eloctrocorporeal shock wave lithotripsy(eswl)
A high pressure shock waves are produced.
These waves are concentrated to the focus(F) of hemi ellipsoid.
At the focus lies our target-the stone.
A biplane X-ray system is used to establish the position of the stone at the focus point.this position is critical.
This method is used for stones<2 cm.
The refloctor and patient are submerged in degassed and demineralised water.
70 to 120 shocks are released per minute.
A 20 or 18 kv voltage is applied to the spark gap according to the need.
ESWL- FOUR MAIN ELEMENTS
ENERGY SOURCE
FOCUSING DEVICE
COUPLING DEVICE
LOCALIZATION DEVICE
ESWL – SPARK GAP/ EHL
Electro-hydraulic Generator Located at Base of Water Bath
Produces Shock wave by Electric Spark Gap of 15,000 to 25,000 Volts Lasting 1 Sec
High Voltage Spark Discharge Rapidly-
evaporates Water & Generators A “Shock Wave” by expanding Sarrounding Liquid
Shock wave production
Electro magnetic technology.
A capacitor is charged to few kilo watts(18 to 20).
We need two electrodes.(that will cause triggering of spark gap).
The capacitor is made to discharge in microseconds resulting in ignition of spark gap.
An ellipsoidal refloctor is needed.
We need a convex lens to focus the shock waves produced at focus of ellipsoid
COUPLING DEVICE
“WATER BATH”
“WATER FILLED CUSHION”
(KEEP PATIENT’S DRY)
localization device(c-arm)
It is an imagining device.
Image intensifier is used to amplify low powered scattered x-rays that got defracted from body.
It produces a live feed in tv .
The higher acceleration of electrons through the lens system is responsible for gain in brightness.
Certain metal salts glows when struck by diffracted x-rays.
Treatment process
Age
Sex
Type of stone.
Position of stone(ureter or kidney)
(these are the inputs which invariably decides the energy and the no of shocks needed)
diagnosis
A dye is injected it in you vein of the arm.
This dye surrounds the stone and shows up in x-ray.
Some people have stent placed prior to lithotripsy procedure.
Pregnancy test for women and ekg test for old.
Mathametical modelling and simulation
No of shocks at 18 kv
Some stats
Conclusions that can be inferred
Cont……..
Limitations
Brusises at the back.
Diabetes
Capillary damage.
The fragmented stone may block the urine passage.
Other session of lithotripsy.
The manual adjustment of electrodes consumes times which causes pain to patient.
You may get ulcers in stomach and small intestine.
Bleeding around kidney may require blood transfusion.
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