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Accurate urology diagnosis is key to treatment. Learn about common screening tests, cystoscopy procedures, and how to prepare for your evaluation at LIV Hospital.
Send us all your questions or requests, and our expert team will assist you.
Before ESWL can be done, doctors must carefully check that the patient is a good candidate. This involves confirming the stone is there, learning about its size and type, and making sure ESWL is the best option. At Liv Hospital, doctors use advanced scans and lab tests to gather this information and predict how well the treatment will work.
Diagnosis usually starts when a patient has symptoms of a stone or when a stone is found by chance. The doctor needs to know the stone’s size, location, and hardness, since these factors affect how well ESWL will break it up and clear it.
The undisputed gold standard for diagnosing urinary tract stones is Non-Contrast Computed Tomography of the Kidneys, Ureters, and Bladder (CT KUB). This imaging modality offers superior sensitivity and specificity compared to other methods.
Anatomical Mapping: The CT scan visualizes the anatomy of the kidney drainage system. A narrow infundibular angle or a long lower-pole calyx might suggest that, even if the stone is broken, the fragments will not drain, contraindicating ESWL.
While CT is the gold standard for detection and characterization, ultrasound plays a vital role in the diagnostic workup and follow-up. It is a radiation-free modality, making it the preferred initial test for pregnant women and children.
Limitations: Ultrasound often fails to visualize stones in the mid-ureter due to bowel gas interference and does not provide information on stone density.
A regular X-ray of the kidneys, ureters, and bladder (KUB) is often used along with a CT scan.
Baseline for Follow-up: It establishes a baseline to compare against post-treatment X-rays, making it easier to track the movement and clearance of fragments (steinstrasse) after the procedure.
Doctors always check the urine with lab tests before doing ESWL.
pH Level: Urinary pH can give clues to the stone composition (e.g., acidic urine suggests uric acid stones), which aids in treatment planning and medical management.
Blood tests are done to check how well the kidneys are working and to make sure the blood clots normally.
Coagulation Profile (PT/INR, PTT): ESWL causes micro-trauma to the kidney. Therefore, patients must have normal clotting function. Patients on blood thinners (anticoagulants) or antiplatelet drugs must stop their medication for a specific period before the procedure to prevent the formation of a perinephric hematoma (bleeding around the kidney).
If a patient keeps getting stones, doctors may ask for a 24-hour urine collection. This test measures things like calcium, oxalate, citrate, and uric acid to find out why stones are forming and to help plan ways to prevent them after ESWL.
Send us all your questions or requests, and our expert team will assist you.
A non-contrast CT scan is preferred because it utilizes 3D imaging to provide much higher detail and sensitivity. Unlike an X-ray, which can miss “soft” stones like uric acid stones or small stones hidden behind bowel gas or bone, a CT scan visualizes virtually all stones regardless of composition. It also enables the measurement of the stone’s hardness (Hounsfield Units), which is the best predictor of whether ESWL will successfully break the stone.
Hounsfield Units (HU) are a measure of density on a CT scan. In the context of kidney stones, hardness indicates the stone’s hardness. A stone with a low HU (e.g., under 600) is softer and likely to shatter easily with shock waves. A stone with a high HU (e.g.,>1000) is tough and resistant to ESWL, suggesting that surgical removal via ureteroscopy may be a more successful option.
No, ESWL is generally contraindicated in patients with an active urinary tract infection. Kidney stones often harbor bacteria within their structure. Breaking the stone can release these bacteria into the urinary system and bloodstream, potentially causing a severe systemic infection called sepsis. The disease must be treated with antibiotics, and the urine must be sterile before the procedure can proceed.
Although ESWL is non-invasive (no incisions), the high-energy shock waves travel through kidney tissue, causing microscopic bruising or trauma. If your blood does not clot normally, or if you are taking blood-thinning medication, this micro-trauma could lead to significant internal bleeding around the kidney (hematoma). Ensuring normal clotting function is a strict safety requirement.
Ultrasound is primarily used to detect hydronephrosis (kidney swelling), which indicates the degree of blockage caused by the stone. It is also used to guide shock waves during the ESWL procedure for radiolucent stones (rocks that cannot be seen on X-ray). However, for initial diagnosis, it is less sensitive than CT because it can miss stones located in the mid-ureter.
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