{"id":6955,"date":"2023-11-21T06:31:11","date_gmt":"2023-11-20T23:31:11","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=6955"},"modified":"2026-04-29T03:45:48","modified_gmt":"2026-04-28T20:45:48","slug":"%d0%b8%d0%bd%d1%81%d1%82%d1%80%d1%83%d0%ba%d1%86%d0%b8%d1%8f-%d0%b4%d0%bb%d1%8f-%d0%bf%d0%b0%d1%86%d0%b8%d0%b5%d0%bd%d1%82%d0%b0-3-%d0%b3%d0%be-%d0%bf%d0%be%d0%ba%d0%be%d0%bb%d0%b5%d0%bd%d0%b8%d1%8f-e","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/ru\/2023\/11\/21\/3rd-gen-eswl-patient-instruction\/","title":{"rendered":"3-\u0435 \u043f\u043e\u043a\u043e\u043b\u0435\u043d\u0438\u0435 \u0438\u043d\u0441\u0442\u0440\u0443\u043a\u0446\u0438\u0439 \u0434\u043b\u044f \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 ESWL"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ru\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Best Urologist working in Chonburi and Cambodia\" 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5.515 0 0 1-.06-.51 19.85 19.85 0 0 1-.025-.726c-.004-.28-.004-.628-.004-1.045 0-.418 0-.766.004-1.046a19.85 19.85 0 0 1 .025-.726 5.475 5.475 0 0 1 .06-.51 3.785 3.785 0 0 1 .111-.43c.108-.44.318-.78.658-1.024.34-.243.82-.357 1.475-.357.6 0 1.064.078 1.413.293.347.215.595.515.74.91.063.155.166.21.31.156l.967-.4c.15-.058.187-.18.13-.32a3.025 3.025 0 0 0-1.262-1.452C21.12.218 20.428.0 19.586 0zM8.512 4.32c-2.7 0-4.066.997-4.066 3.06v.04c0 1.92.992 2.83 3.046 2.83 1.27 0 2.038-.39 2.385-1.05h.13l.067.51c.04.2.207.34.41.34h.99V7.95c0-2.59-1.06-3.63-2.962-3.63zm-.18 1.61c1.118 0 1.628.56 1.628 1.86v.4l-1.65.16c-1.35.13-1.86.46-1.86 1.13v.04c0 .67.41 1.06 1.45 1.06.85 0 1.55-.32 1.93-.84.04-.06.13-.07.18-.02.05.03.07.1.07.16v.43c0 .26.13.42.34.42h1.05c.21 0 .34-.16.34-.42v-3.6c0-1.94-1.13-2.83-3.46-2.83-1.94 0-3.07.86-3.4 2.04l1.55.45c.18-.69.6-1.04 1.83-1.04zM2.135 16.314c-.587 0-1.066-.156-1.434-.469-.367-.312-.618-.704-.752-1.176-.034-.124-.061-.232-.082-.327a3.794 3.794 0 0 1-.044-.366 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1-.04.342 1.732 1.732 0 0 1-.064.262c-.13.523-.402.913-.815 1.17-.413.255-.95.382-1.61.382z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/orcid.org\/0009-0004-8387-3559\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"ORCID iD\"\n     aria-label=\"View ORCID Profile\"\n     style=\"text-decoration: none; color: #A6CE39; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M12 0C5.372 0 0 5.372 0 12s5.372 12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">There\u2019re questions came up from the patients for what and how the difference between the patient\u2019s instruction on 3<sup>rd<\/sup> and 4<sup>th<\/sup> of the ESWL? I\u2019m going to state it deliberately only on the 3<sup>rd<\/sup> generation in this topic.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a> <a href=\"tel:02-310-3009\">02-310-3009<\/a> <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi <a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If you would like to review the 4<sup>th<\/sup> Generation of ESWL patient\u2019s instructions \u2013 <a href=\"https:\/\/drsoaraweeurology.com\/2021\/03\/19\/post-eswl-patient-instructions\/\">please visit this link.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 4<sup>th<\/sup> Generation ESWL synchronizes with human breathing achieving a 98.5% stone hit rate, while the 3<sup>rd<\/sup> 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.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Post 3<sup>rd<\/sup> Generation ESWL Patient Instructions<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\">Right after the ESWL procedure<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>You will be awoken by the anesthesiologist after moderate sedation.<\/li>\n\n\n<li>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.<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">The first several days after ESWL<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"2570\" data-permalink=\"https:\/\/drsoaraweeurology.com\/ru\/2021\/03\/19\/post-eswl-patient-instructions\/bloody-urine\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;9&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark II&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1496247011&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;80&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Bloody urination &amp;#8211; Almost 100%\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Bloody urination &amp;#8211; Almost 100%&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Post-ESWL patient instructions\" class=\"wp-image-2570\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/03\/Bloody-urine.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Bloody urination &#8211; Almost 100%<\/figcaption><\/figure>\n\n\n\n<h5 class=\"wp-block-heading\">Within 30 days after ESWL<\/h5>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Steinstresse risk 4-7% \u2014 Shattered stone fragments may accumulate in the ureter, causing flank pain or remaining asymptomatic.<\/li>\n\n\n<li>Residual stone risk 21-59% \u2014 Fragments under 4 mm are considered unremarkable and may pass spontaneously. Regular ultrasound follow-up is recommended.<\/li>\n\n\n<li>Stone pain risk \u2014 Shattered fragments may trigger sudden pain. Maintain high fluid intake (2-3 liters\/day). Oral medication can help reduce post-ESWL stone pain.<\/li>\n\n\n<li>Blood stream infection risk 1-2.7% \u2014 Bacteria residing in stones may enter the bloodstream. Routine antibiotics are not prescribed; fever monitoring after the procedure is recommended.<\/li>\n\n\n<li>Major kidney bleeding &lt;1% \u2014 Severe kidney injury is rarely reported as ESWL is the least invasive kidney stone procedure.<\/li>\n<\/ol>\n\n\n\n<h5 class=\"wp-block-heading\">Long-term complications<\/h5>\n\n\n\n<p class=\"wp-block-paragraph\">No existing evidence supports any long-term complications from ESWL, per EAU 2020 recommendations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you have any questions on the 3<sup>rd<\/sup> Generation ESWL procedure, please talk to your trusted urologist, or it would be my pleasure if you text me. Take care!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You can visit my official homepage <a href=\"https:\/\/drsoaraweeurology.com\/\">here<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Q1: What is 3rd generation ESWL and how is it different from 4th generation?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">3rd generation ESWL delivers shockwaves to break kidney stones but does not synchronize with the patient&#8217;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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q2: Is bloody urination normal after ESWL?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q3: What is Steinstresse and should I be worried?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Steinstresse is a German term meaning &#8220;stone street&#8221; \u2014 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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q4: How long does it take to know if ESWL was successful?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q5: Does ESWL cause long-term kidney damage?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you have kidney stones and would like to explore ESWL treatment options, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Book a Consultation<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@type\": \"FAQPage\",\n  \"mainEntity\": [\n    {\"@type\": \"Question\", \"name\": \"What is 3rd generation ESWL and how is it different from 4th generation?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"3rd generation ESWL delivers shockwaves to break kidney stones but does not synchronize with breathing, resulting in an 82.6% hit rate in awake patients. 4th generation ESWL uses respiratory gating to synchronize with breathing, achieving 98.5% accuracy. Sedation is used with 3rd generation ESWL to control breathing and improve results.\"}},\n    {\"@type\": \"Question\", \"name\": \"Is bloody urination normal after ESWL?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes. 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If you would like to review the 4th Generation of ESWL patient\u2019s instructions \u2013 please visit this [&hellip;]<\/p>\n","protected":false},"author":185281453,"featured_media":10008,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"What to expect after 3rd generation ESWL for kidney stones \u2014 bloody urine, Steinstresse, residual stone risk, and long-term safety. 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