Should I Undergo ESWL Again After Previous Complications?

Is it appropriate to undergo extracorporeal shock wave lithotripsy again?

Dear Doctor: I underwent a left ureteroscopy to remove a stone at the beginning of October, and I still have a double J stent in place that needs to be removed.
During my follow-up appointment last week, an X-ray showed that there is still a stone located higher up that cannot be grasped.
The doctor recommended extracorporeal shock wave lithotripsy (ESWL).
However, about 6 or 7 years ago, I had a lithotripsy procedure for my right kidney at National Taiwan University Hospital without any complications.
Then, about 5 or 6 years ago, I had a lithotripsy for my left kidney at this hospital (which is closer to my home), but I ended up in the emergency room that evening.
After a CT scan, the doctor diagnosed me with a renal hematoma, and I was urgently hospitalized for a blood transfusion, staying for about 5 days before being discharged.
Therefore, I am very concerned that if I undergo ESWL again, there is a possibility of developing another hematoma in my left kidney.
Is my left kidney resilient enough to withstand another hematoma? What is the likelihood of experiencing another hematoma? During my outpatient visit, the doctor acknowledged my concerns and suggested monitoring for another 2 weeks, but I have a follow-up appointment next Thursday.
Should I follow this doctor's recommendation and take the risk of undergoing ESWL again at this hospital, or should I transfer to National Taiwan University Hospital for the procedure? The issue is that my double J stent was placed by this hospital; will National Taiwan University Hospital be able to manage that?

FreeShow, 60~69 year old female. Ask Date: 2017/11/02

Dr. Du Shixi reply Urology

A physician must not administer treatment, prescribe medication, or provide a diagnosis without a personal examination.
Hello: The likelihood of developing a renal hematoma is very low.
If you need to undergo lithotripsy again, you should inform the physician of this medical history.
If you are taking any medications, please provide that information for the physician's reference, as some medications can increase the risk of bleeding.
The physician will make the decision.
If you go to National Taiwan University Hospital, they should be able to manage your case as well.
As for the subsequent treatment direction, it will be up to National Taiwan University Hospital to decide whether surgery or lithotripsy is necessary, based on the physician's recommendations.

Reply Date: 2017/11/02

More Info

When considering whether to undergo Extracorporeal Shock Wave Lithotripsy (ESWL) again after previous complications, it's essential to weigh the risks and benefits carefully. Your history of complications, particularly the renal hematoma following a previous procedure, understandably raises concerns about the safety of repeating the procedure on your left kidney.

ESWL is a non-invasive procedure that uses shock waves to break kidney stones into smaller pieces, making them easier to pass. While generally safe, complications can occur, especially in patients with a history of issues like renal hematomas. A renal hematoma is a collection of blood outside of the kidney, which can occur due to trauma or surgical intervention. In your case, the concern is whether your left kidney can withstand another procedure without the risk of developing another hematoma.

The fact that you had a significant complication during your last ESWL procedure on the left kidney is a critical factor to consider. The risk of recurrence of a hematoma can depend on several factors, including the size and location of the stone, the technique used during the procedure, and your overall kidney health. If your left kidney has already been compromised, it may be more susceptible to complications.

Your physician's recommendation to observe for an additional two weeks before making a decision is prudent. This observation period allows for monitoring any changes in your condition, including the size of the remaining stone and any potential symptoms that may arise. If the stone is not causing significant symptoms, it may be worth considering a conservative approach, such as waiting to see if it passes on its own or exploring alternative treatments.

If you are still concerned about the risks associated with ESWL, it may be beneficial to seek a second opinion, particularly from a urologist at a different institution, such as National Taiwan University Hospital (NTUH), where you previously had a successful procedure. They may provide insights into whether they can safely perform the ESWL given your history and whether they can manage the double-J stent that was placed by your current hospital.

In terms of the double-J stent, it is typically removable by the physician who placed it, but other urologists can also manage it. If you decide to switch hospitals, ensure that the new urologist is aware of your complete medical history, including the placement of the stent and any complications you have experienced.

Ultimately, the decision should be based on a thorough discussion with your healthcare provider, weighing the potential benefits of the procedure against the risks of complications. If you feel uncomfortable with the proposed plan or have lingering concerns, advocating for a second opinion is always a reasonable course of action. Your health and peace of mind are paramount, and ensuring that you feel confident in your treatment plan is essential.

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