SPECIALIST FACILITIES

Indications for an ESWL procedure:

• calyceal nephrolithiasis in the case concrement growth or difficulties in urine flow,
• concrement in the renal pelvis,
• stone in the ureter.

ESWL PROCEDURE

ESWL - Extracorporeal Shock Wave Lithotripsy.

Lithotripsy is the least-invasive method of nephrolithiasis treatment, often preventing the need to perform surgical treatment. Currently, it is the most frequent method of treatment of urinary lithiasis.

The procedure is performed when the patient is lying down, in a position enabling the maximum effect of the shock wave. Subsequently, the concrement to be fragmented is localised with the use of X-ray and ultrasound. Contemporary lithotripters automatically adjust the strength of the shock wave necessary to crush the concrement. The number of shock wave impulses necessary for the concrement to disintegrate depends on the size, hardness and location of the stone. If the ESWL is effective, the concrement is disintegrated - fragmented and then removed by the patient with the urine. Excretion of the fragments may last from several hours to about a dozen weeks.

The procedure is performed by a urologist with the assistance of an experienced nurse. The duration of each procedure is adjusted individually to the size of the stone and its location. All ESWL procedures are performed on fully conscious patients, there is no need for general or conduction anaesthesia. After the procedure, the patient leaves the hospital with recommendations.

After lithotripsy, it is recommended to do exercises facilitating the excretion of the concrement fragments. Recommendations include climbing stairs, jumping and riding a bicycle. Depending on the location of the stone, the urologist may recommend lying on the left/right side, deep forward bends or lying with a raised pelvis.

After ESWL, the patient should be monitored by the urologist in order to assess the degree of concrement disintegration and chances of excreting the fragments on one's own. Follow-up ultrasound and plain kidney and bladder X-rays are obligatory for every patient after ESWL.

DAY BEFORE THE PROCEDURE

On the day before the procedure you can eat and drink normally, but avoid carbonated drinks.

ON THE PROCEDURE DAY THE PATIENT SHOULD:

• be fasting, the last meal should be eaten no later than 6 hours before the planned procedure,
• take all his/her medicines with a small amount of still water, with the exception of medicines decreasing blood coagulation capacities.

ESWL PROCEDURE

When arriving at an ESWL procedure, please bring:

• referral for the ESWL procedure containing the name of the patient (from a urology specialist),
• health insurance card of the person belonging to the Silesia Province Department of the National Health Fund,
• Identification Card or other document confirming one's identity,
• the unemployed - certificate from the Regional Employment Office,
• medical documentation (hospital discharge summaries, current laboratory tests: CBC, urinalysis, creatinine, APTT and X-ray documentation).

In the Urodynamic Laboratory, we perform examinations assessing the activity of the lower urinary tract - bladder and urethra.

Indications for urodynamic examinations:

All symptoms related to lower urinary tract:

• stress incontinence,
• urinary urgency,
• incontinence because or urinary urgency,
• difficulties in urination,
• recurring urinary infections.

The examination includes the measurement of the amount of excreted urine, time of urination, pressure in the bladder and the rectum and sphincter activity.

STAGES OF URODYNAMIC EXAMINATION

Uroflowmetry:

The examination involves the assessment of the urine collection phase and consists in urination into a special device called uroflowmeter. The examination is non-invasive and totally painless. It is performed when the patient strongly needs to urinate.

Cystometry:

Cystometry is an invasive part of the urodynamic examination as it requires the insertion of a catheter into the bladder. It is an examination assessing the relationship between the pressure and volume of the bladder while it is being filled. During the urodynamic examination, a thin catheter is inserted to the bladder in order to fill it with saline and register the pressures inside. The moment of catheter insertion is unpleasant and may cause some discomfort. Additionally, the pressure in the rectum is measured with another catheter inserted into it. The activity of sphincter muscles is determined thanks to surface electrodes. After the bladder is filled, the patient urinates through a special device (uroflowmeter) which measures the amount of urine and the speed of urination. During urination, the pressure in the bladder and abdominal cavity as well as sphincter activity are registered. After a comprehensive analysis of the examination results, the patient receives results with conclusions as to further therapy.

BEFORE THE EXAMINATION

1. Directly before the URD examination, the patient must submit:

• Current results of urinalysis or urine culture,
• full medical documentation of surgeries (if applies),
• micturition diary.

The doctor may recommend the usage of a glycerin suppository or an enema in the evening of the day preceding the examination day.

DOCUMENTS NECESSARY ON ADMISSION FOR THE URD EXAMINATION

When arriving at the URD examination, please bring:

• a referral to the Specialist Urology Outpatient Clinic issued by a general practitioner,
• a referral to urodynamic examination from a urologist or gynaecologist,
• health insurance card of the person belonging to the Silesia Province Department of the National Health Fund,
• Identification Card or another document confirming one's identity,
• the unemployed - certificate from the Regional Employment Office,
• medical record number assigned in the Registration of the Urology Clinic, if this is not the first visit,
• medical documentation (hospital discharge summaries, laboratory tests, X-ray documentation, etc.).

THE X-RAY FACILITY IS DIVIDED INTO TWO PARTS: DIAGNOSTIC PART AND PROCEDURE PART.

In the diagnostic part, the patients are diagnosed before procedures and often the scans done there have a direct impact on the type of the performed procedure.

In the diagnostic part of the X-ray facility, we perform, among others, the following examinations:

• Plain abdominal X-ray - done to visualize the lesions in the urinary system. Because of the hospital's specialisation, the scan is made as a routine procedure in the majority of newly admitted patients. In patients after PCNL and URSL procedures, it is used as a follow-up in order to assess the effects of the procedure.
• PA chest X-ray - done in patients to be anaesthetized during a surgery in order to assess the condition of the heart and lungs.
• Urography - X-ray examination with the use of contrast, aimed at the assessment of the excreting activity of the kidneys, condition of the pyelocalyceal system, ureters and urinary bladder.
• Retrograde pyelogram - examination involving the administration of contrast through a ureteral probe in order to assess its continuity and shape (if not visualised on other scans) or check the location of the obstruction impeding the renal function.
• Antegrade pyelogram - examination involving the administration of contrast through a drain located in the kidney, usually in order to assess the position of the drain or check the location of the obstruction impeding the renal function.
• Cystography - examination in which the urinary bladder is filled with a contrast agent. It is performed in patients with suspicion of a "hole" in the bladder. The image is done with the maximum bladder filling and after emptying the bladder.
• Voiding cystourethrogram - examination in which the urinary bladder is filled with a contrast agent and the X-ray image is made during urination. It is performed in patients with vesicoureteral reflux and women with urinary incontinence.
• Retrograde urethrogram - examination involving the administration of a contrast agent to the urethra in order to assess lesion in this area. After the administration of the contrast, an X-ray image is made. The examination is performed in men.

In the procedure part, the patients undergo the procedures of fragmentation and removal of ureteral or kidney stones, kidney decompression in the case of urinary obstruction, laser treatment of uretero-pelvic junction stricture. Female patients at a reproductive age are admitted to the aforementioned procedure after prior exclusion of pregnancy in the form of blood pregnancy test.

• Percutaneous nephrolithotomy (PCNL) - removal of kidney stones with the use of endoscopic tools under visual and X-ray control. X-ray is used to visualize the renal puncture and assessment if the tools are located in the place enabling the removal of the calculus.
• Ureteroscopic lithotripsy (URSL) - procedure consisting in fragmentation and removal of a calculus located in the ureter with the use of endoscopic tools under visual and X-ray control. X-ray is rarely used in this procedure, in order to assess the position of the tools or ureteral probe or check the location of the calculus.
• Ureteroscopy (URS) - procedure involving the insertion of ureteroscope to the ureter for diagnostic purposes or in order to insert a ureteral catheter. Sometimes the procedure includes a retrograde pyelogram. X-ray is rarely used in this procedure. It is used to assess the catheter position and for retrograde pyelogram.
• Percutaneous nephrostomy (PCN) - procedure in which the kidney is punctured in order to remove the fluid from the obstructed kidney and decompress the pyelocalyceal system. The procedure is performed under X-ray and ultrasound control. X-ray radiation is used for the assessment of correct location of the tools during the puncture and at the end to check the correct position of the nephrostomy tube.
• Ureteral catheterization - procedure of insertion of a ureteral catheter to the kidney with the use of a cystoscope. X-ray is used in order to assess the position of the catheter in the kidney or ureter.

DIAGNOSTIC X-RAY FACILITY IS EQUIPPED WITH THE FOLLOWING X-RAY MACHIES:

• ARCADIS ORBIC c-arm, a mobile X-ray machine with a video channel and monitors, used during the PCN, PCNL,URS, URSL procedures, ureteral catheterization and retrograde pyelogram. It is equipped with Dose Area Product detector, pulsed fluoroscopy and option of saving the patient data and fluoroscopy images in the case of need. The recorded images and patient data may be burnt onto a CD.
• UROMAT 3000, an X-ray set equipped with a remotely controlled wall and two screens. It is used during the PCN, PCNL,URS, URSL procedures, ureteral catheterization and retrograde pyelogram. It is equipped with Dose Area Product detector, pulsed fluoroscopy and option of saving the patient data and fluoroscopy images in the case of need. The recorded images and patient data may be burnt onto a CD, DVD or other digital memory.
• AXIOM ICONOS R100 - X-ray set equipped with a remotely operated wall, chest scan tripod and monitor. It is used for scans and X-ray examination with the use of contrast media. The most frequent scans and examination involve: plain abdominal X-ray, PA chest X-ray, urography, retrograde pyelogram, antegrade pyelogram, cystography, voiding cystourethrogram, retrograde urethrogram. Due to the specificity of the hospital, no other types of X-ray scans and examinations are performed.