Can Patients with Stroke Safely Undergo Extracorporeal Shock Wave Lithotripsy? - Urology

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When considering whether patients who have had a stroke can safely undergo extracorporeal shock wave lithotripsy (ESWL), several important factors must be taken into account. Your father's medical history, including his stroke and current medications, plays a crucial role in determining the safety of this procedure.

Firstly, it is essential to understand that extracorporeal shock wave lithotripsy is a non-invasive procedure used to treat kidney stones by using shock waves to break the stones into smaller pieces that can be passed more easily. While this procedure is generally considered safe for many patients, those with a history of stroke, particularly if they are on anticoagulant therapy, may face increased risks.

In your father's case, he has been prescribed anticoagulants to prevent further strokes, which is a standard practice for patients with a history of cerebrovascular accidents. The concern with stopping anticoagulant therapy before undergoing ESWL is that it may increase the risk of thromboembolic events, such as another stroke or heart attack. On the other hand, continuing anticoagulants during the procedure could increase the risk of bleeding, especially if there are any complications during the lithotripsy.

The recommendation from your father's neurologist to postpone the procedure for six months is likely based on a careful assessment of his vascular health and the risks associated with stopping anticoagulants. It is crucial to weigh the risks of delaying treatment for the kidney stones against the potential complications that could arise from undergoing the procedure while on anticoagulants.

Regarding the kidney stones and hydronephrosis (swelling of the kidney due to urine buildup), it is important to address the pain and potential kidney function deterioration. If the hydronephrosis is significant, it could lead to kidney damage over time. Therefore, it is essential to communicate with both the urologist and neurologist to find a balanced approach to managing your father's condition.

Here are some potential solutions and considerations:
1. Multidisciplinary Consultation: It may be beneficial to have a meeting involving both the neurologist and urologist to discuss your father's case in detail. This can help ensure that both specialists are aware of each other's concerns and can collaborate on a safe plan.

2. Alternative Pain Management: While waiting for the procedure, explore options for managing your father's pain. This could include medications that are safe for his condition or non-pharmacological approaches such as physical therapy or acupuncture.

3. Monitoring Kidney Function: Regular monitoring of kidney function is essential. If there are signs of deterioration, it may necessitate a more urgent intervention.

4. Consideration of Other Procedures: If ESWL is deemed too risky, other options for managing kidney stones, such as ureteroscopy or percutaneous nephrolithotomy, may be considered, depending on the size and location of the stones.

5. Patient Education: Educate your father about the signs of complications from hydronephrosis, such as worsening pain, fever, or changes in urine output, so that he can seek immediate medical attention if needed.

In conclusion, while the decision to proceed with ESWL in a patient with a history of stroke and on anticoagulants is complex, it is essential to prioritize both the management of kidney stones and the prevention of further strokes. Close collaboration between healthcare providers and careful monitoring of your father's condition will be key to ensuring his safety and well-being.