1. 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

3. 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. .

4. What's cause kidney stone:
-dehydration
-sodium intake
-Excess
-urinary tract infection -

5. :Types of Kidney Stones
calcium oxalate
Calcium phosphate
Uric Acid
Struvite
Cystine

6. Kidney stone symptom when kidney stones move through the urinary tract they may causes :
-Severe pain in the back
Abdomen , or groin
-Frequent or painful urination
-Blood in the urine
Fever / chills-
-Nausea and vomiting

7. physician will ask question about your pain
Diagnosis:
physician will ask question about your pain
Urinalysis
X ray studies :
CT abdomen/ pelvis
KUB

8. Kidney Stones Treatment
ESWL : Extracorporeal shock wave lithotripsy
Ureteroscopy
PCNL
nephrolithotomy

9. Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones
Extracorporeal 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

10. Penetrating the body without damaging tissue
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. -

14. Patient lie on a water-filled cushion, and the
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.

15. 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

16. 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

17. . 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 -

18. 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 ).

19. 4_apply plenty of silicon oil 100 to the coupling
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 coupling
5-if stone in kidney or upper urter , patient supine position if stone in lower urter patient prone position

20. Treatment recommendations
Kidney:
Maximum: pulses---energy level 5.0*
3000 pluses------energy level 6.0*
Ureter:
Maximum: 4000 pulses_____energy level 7.0*
3000pluses ______energy level 8.0*

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

22. Maximum values that are not necessary for every treatment
***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.

23. 1-swivel therapy head out.
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).

24. 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

25. . 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

26. 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

27. 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

28. ESWL does not successfully treat cystine kidney stones
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

29. 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.

30. Side-effects Side-effects of lithotripsy include:
These 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