Post-ESWL Recovery: Symptoms and Follow-Up Care

Q: Post-ESWL Recovery: Symptoms and Follow-Up Care

Hello： After lithotripsy, it is important to observe for symptoms, as some may occur. <br>The time for stone passage is difficult to predict, but stones typically do not remain for an extended period (such as six months), unless you have not followed the post-procedure care instr

Post-operative follow-up after ESWL (Extracorporeal Shock Wave Lithotripsy)

Hello Doctor: I previously had a 0.6 cm stone in the lower ureter that was stuck for nearly two months.
After undergoing extracorporeal shock wave lithotripsy (ESWL), I returned for a follow-up appointment a week later, and the X-ray showed that the stone had moved down about 2 cm (the stone is now 3-4 cm from the bladder).
The stone and its outline appeared more blurred on the X-ray.
At that time, the urologist advised me to drink plenty of water and take Buscopan to help facilitate the passage of the stone.
Since the ESWL, it has been over ten days; initially, I experienced dull pain in the left flank, but now it has only slightly subsided and does not affect my daily life.
Occasionally, I feel slight twitching in the left lower abdomen and left flank.
In the past couple of days, I've noticed some itching in the urethra at the penile area and a sensation of residual urine.
I would like to ask if these are normal symptoms after stone fragmentation? Additionally, since I will be studying abroad starting August 13 for about a year and will return to Taiwan twice, is it feasible to wait six months for a follow-up while drinking over 2000 ml of water daily? Will this six-month period affect my daily routine? I hope the stone will pass on its own, but I have observed that my urine has been slightly cloudy only once or twice in the past few days.
Should I consider having the stone removed before going abroad? Also, what would be an appropriate time frame for scheduling a follow-up X-ray examination? Thank you!

TT, 20~29 year old female. Ask Date: 2019/07/21

Dr. Du Shixi reply Urology

Hello: After lithotripsy, it is important to observe for symptoms, as some may occur.
The time for stone passage is difficult to predict, but stones typically do not remain for an extended period (such as six months), unless you have not followed the post-procedure care instructions.
If you are very concerned, an endoscopic retrieval can be performed.
As for the follow-up appointment, it is usually scheduled for 3-4 weeks later.
Wishing you good health.
Please pay attention to your lifestyle habits, as stones can recur.

Reply Date: 2019/07/21

More Info

Post-Extracorporeal Shock Wave Lithotripsy (ESWL) recovery can be a nuanced process, and it’s important to understand the symptoms you’re experiencing as well as the necessary follow-up care. Based on your description, it seems you are experiencing some common post-ESWL symptoms, but let’s break it down further.

Understanding Your Symptoms
1. Left Flank Pain: It’s not uncommon to experience some discomfort in the flank area after ESWL. This can be due to the passage of stone fragments through the urinary tract. The initial pain you felt, which has now reduced to mild discomfort, is a positive sign that your body is adjusting and the fragments may be moving towards the bladder.

2. Twitching Sensation: The occasional twitching or "small shaking" sensation in your lower abdomen and left flank can also be attributed to the movement of stone fragments or spasms in the urinary tract. This is generally not a cause for concern unless it is accompanied by severe pain or other alarming symptoms.

3. Urethral Itching and Sensation of Residual Urine: The itching sensation in the urethra and the feeling of residual urine can occur after ESWL. This might be due to irritation from stone fragments or the procedure itself. If these symptoms persist or worsen, it would be advisable to consult your urologist.

4. Mild Cloudiness in Urine: Some cloudiness in urine can be expected as stone fragments pass through the urinary system. However, if you notice persistent cloudiness, blood, or a foul odor, it could indicate an infection or other complications, and you should seek medical attention.

Follow-Up Care and Recommendations
- Hydration: Continue to drink plenty of fluids (at least 2000 mL per day) to help flush out the stone fragments. Staying well-hydrated is crucial in preventing further stone formation and aiding in the passage of any remaining fragments.

- Follow-Up Appointments: It is generally recommended to have a follow-up appointment with your urologist about 4-6 weeks after the procedure. This allows enough time for any remaining fragments to pass and for your doctor to assess your recovery through imaging, such as an X-ray or ultrasound.

- Travel Considerations: Since you plan to travel abroad for a year, it’s important to discuss your travel plans with your urologist. If your symptoms remain mild and manageable, and if your doctor agrees, it may be acceptable to wait until you return for a follow-up. However, if you experience any worsening symptoms, such as increased pain, fever, or changes in urination, you should seek medical attention immediately, regardless of your location.

- Monitoring Symptoms: Keep a close eye on your symptoms. If you notice any significant changes, such as increased pain, fever, or changes in urine color or consistency, it’s crucial to seek medical attention sooner rather than later.

Conclusion
In summary, while some discomfort and mild symptoms can be expected after ESWL, it’s essential to monitor your condition closely. Staying hydrated and maintaining communication with your healthcare provider will be key to ensuring a smooth recovery. If you have any concerns or if your symptoms change, do not hesitate to reach out to your urologist for guidance. Safe travels and best wishes for your studies abroad!

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