ESWL の患者指導の第 3 世代

最終更新日： 2026年4月29日

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ESWLの3^番目と4^番目の患者指導の違いは何なのか、どのように違うのか、患者から質問が出た。このトピックでは、あえて3^回目に限って述べることにする。

• 泌尿器センター バンコク病院 タイ オンライン予約 02-310-3009 bhquro@bdms.co.th
• サミティジ・シラチャ病院 チョンブリ 088-022-1445

第4^世代のESWL患者用説明書をご覧になりたい場合は、こちらのリンクをクリックしてください。

The 4^NS Generation ESWL synchronizes with human breathing achieving a 98.5% stone hit rate, while the 3^rd generation misses the target 82.6% of the time in awake patients. Sedation by an anesthesiologist is used to control breathing rhythm and improve accuracy.

Post 3^rd Generation ESWL Patient Instructions

ESWL処置直後

• You will be awoken by the anesthesiologist after moderate sedation.
• After 1-2 hours of observation in the recovery room, you will be transferred to the ward for overnight observation to monitor for sedation side effects such as dizziness or nausea.

The first several days after ESWL

• Almost 100% of patients experience bloody urination caused by the shockwave effect on surrounding kidney tissue. Drink 2-3 liters of water daily to flush out residual blood.

Within 30 days after ESWL

1. Steinstresse risk 4-7% — Shattered stone fragments may accumulate in the ureter, causing flank pain or remaining asymptomatic.
2. Residual stone risk 21-59% — Fragments under 4 mm are considered unremarkable and may pass spontaneously. Regular ultrasound follow-up is recommended.
3. Stone pain risk — Shattered fragments may trigger sudden pain. Maintain high fluid intake (2-3 liters/day). Oral medication can help reduce post-ESWL stone pain.
4. Blood stream infection risk 1-2.7% — Bacteria residing in stones may enter the bloodstream. Routine antibiotics are not prescribed; fever monitoring after the procedure is recommended.
5. Major kidney bleeding <1% — Severe kidney injury is rarely reported as ESWL is the least invasive kidney stone procedure.

Long-term complications

No existing evidence supports any long-term complications from ESWL, per EAU 2020 recommendations.

If you have any questions on the 3^rd Generation ESWL procedure, please talk to your trusted urologist, or it would be my pleasure if you text me. Take care!

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お客様からよくいただくご質問

Q1: What is 3rd generation ESWL and how is it different from 4th generation?

3rd generation ESWL delivers shockwaves to break kidney stones but does not synchronize with the patient’s breathing, resulting in a stone hit rate of approximately 82.6% in awake patients. 4th generation ESWL uses respiratory gating technology to synchronize shockwaves with breathing, achieving a 98.5% hit rate. For 3rd generation ESWL, sedation is used to control breathing and improve accuracy.

Q2: Is bloody urination normal after ESWL?

Yes. Bloody urination occurs in almost 100% of patients after ESWL due to the shockwave effect on surrounding kidney tissue. It is expected and not dangerous. Drinking 2-3 liters of water daily helps flush out residual blood and stone fragments. The bloody urination typically clears within a few days.

Q3: What is Steinstresse and should I be worried?

Steinstresse is a German term meaning “stone street” — a condition where shattered stone fragments accumulate in the ureter, forming a column of debris. It occurs in 4-7% of ESWL cases and can cause flank pain or remain asymptomatic. Your urologist will monitor for this with follow-up imaging and manage it appropriately if it develops.

Q4: How long does it take to know if ESWL was successful?

Follow-up imaging is typically performed 4-6 weeks after ESWL to assess stone clearance. Residual stone fragments of less than 4 mm are considered clinically insignificant and may pass spontaneously. For larger residual fragments, additional ESWL sessions or alternative stone treatment may be recommended. Regular follow-up ultrasound is advised long-term as residual stones have a 21% chance of regrowth over 5 years.

Q5: Does ESWL cause long-term kidney damage?

According to EAU (European Association of Urology) 2020 guidelines, no existing evidence supports long-term kidney damage from ESWL when performed appropriately. ESWL remains one of the safest and least invasive kidney stone treatments available. However, patients with a history of multiple ESWL sessions or pre-existing kidney disease should discuss long-term monitoring with their urologist.

If you have kidney stones and would like to explore ESWL treatment options, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. 診療をご予約.

**免責事項:** このコンテンツは、バンコク病院本部の認定泌尿器科医であるSoarawee Weerasopone博士によって作成およびレビューされました。教育目的のみのものであり、医学的アドバイスを構成するものではありません。いかなる医療処置を開始する前にも、必ず資格のある医療専門家にご相談ください。.