Postop Instructions for Shock Wave Lithotripsy

24 hours postop

Do not drive a car or operate machinery for 24 hours after anesthesia. Do not consume alcohol, tranquilizers, sleeping medication or any non-prescription medication for 24 hours after anesthesia or if taking a pain medication.

Diet

After anesthesia, begin with clear liquids. Avoid any heavy meals on the day of the procedure. Depending on how you feel the following day, you may resume your normal diet. Take plenty of fiber and water or over the counter stool softener to avoid constipation.

Activity

You may resume you normal activity. Being active helps stone fragments pass. You may shower or bathe as you normally do.

Symptoms

• You may have pain while passing stone fragments. You may have frequent urination or a sense of urgency, which is the feeling that you have to get to the bathroom right away. There may be pain or burning with urination. You may see blood, blood clots and stone fragments in the urine. Some people pass stone fragments the day of surgery, some take six weeks to pass all the fragments.

• Urinate into the strainer to save stone fragments. Bring the stone fragments to your postop appointment so they can be sent for analysis. There may be many or there may be none at all.

Medication

• You can obtain good pain relief by taking two acetaminophen (Tylenol) every four hours while awake for the first several days. You may also get a prescription for pain pills. You can use these prescription pain pills in addition to acetaminophen every four hours. Many prescription pain pills have acetaminophen (Tylenol) in them. Do not take more than 4000 mg acetaminophen per day.
• You may also be given a prescription for tamsulosin (Flomax), this helps relax the urinary system to help with passage of stones. This also decreases stent pain if you have a stent. Take this once or twice daily.

Imaging [X-RAY (KUB) or ultrasound]

YOU WILL NEED TO GET AN X-RAY (KUB) OR ULTRASOUND TWO WEEKS AFTER SURGERY. THIS WILL HELP DETERMINE HOW MUCH STONE HAS PASSED AND WHAT THE NEXT STEP WILL BE

Postoperative appointment

Call the office to set up a post operative visit three weeks after the procedure if you don’t already have an appointment. You will must have had your xray or ultrasound well in advance of this appointment so the radiologist and your doctor have time to review it.

Instructions for passing stone: Stones cause trouble when they obstruct or block the ureter, the tube which drains urine from the kidney to the bladder. Pain can come and go, depending on the degree of obstruction. If the stone is sitting in the ureter without causing blockage, there may be little or no pain. However, if the stone turns even slightly, it may cause partial or complete blockage, which can cause gradual or sudden onset of severe pain. The last segment of the ureter runs through the wall of the bladder.

Stones may become stuck in the ureter as it enters the bladder. If so, they can cause urinary symptoms, including frequency (the need to urinate more frequently than usual), urgency (the need to urinate as soon as the urge to go is felt), and postvoid fullness (the sense of the need to urinate further even after one has urinated). These symptoms mimic the symptoms of urinary tract infection. Patients may think they have a bladder infection, but most often these voiding symptoms are due to the stone. When stones are in the lower part of the ureter, they may also cause pain that is referred to the testicle or the tip of the penis in men or into the vaginal and urethral area in women

Tips to help you pass stone fragments

Drink plenty of fluids to promote increased urinary flow which may help pass stone pieces

Be active. Patients are encouraged to be up and about walking which may stone pieces pass.

Flomax (tamsulosin) is a prescription medicine that helps you pass stone. It is used for enlarged prostate in men but also relaxes the kidney tube and promotes stone passage. Flomax is safe to use in both men and women. It can be taken once or twice daily. If it makes you dizzy, take it before bed or stop taking it.

When pain hits, sitting in a tub of hot water or taking a hot shower may offer relief while waiting for the pain pills to take effect. A heating pad, ice pack or BenGay on the affected side may also help.

When pain hits, take up to two pain pills every three hours as needed. You can also take two Tylenol every three hours in addition to the pain pills. Many prescription pain pills have acetaminophen (Tylenol) in them. Do not take more than 3000 mg of acetaminophen (Tylenol) in 24 hours. Taking the pain pills with food may lessen the potential for nausea.

At times, the pain can be so severe that the above measures will not provide relief. If that happens, or if there is fever, vomiting and you are unable to keep down your pills, it is time to go to the emergency room for intravenous fluids and intravenous pain medications. We do not have intravenous fluid or pain medication available through the doctors or the office. You do not need to call the doctor when pain becomes this severe. It is best to go directly to the emergency room promptly so they can get you comfortable, and the doctors there will contact us as needed.

Please note that due to narcotic regulations, our office will only give prescriptions or call in prescription for pain pills only during regular office hours. We cannot call in prescriptions for any pain medication after hours or on weekends. If you sense you may not have enough pills to manage stone pain, you need to contact the office during regular hours for additional pills.