Urology - Kidney Stone Centre

Treatment options

Getting ready for your shockwave lithotripsy (SWL)

Once you have been approved for shockwave lithotripsy, it's important to follow the instructions outlined below in order to avoid treatment cancellation and delays.

Scheduling your appointment

  • Your check-in time is earlier than your scheduled treatment time. This is to give medical staff time to assess you before the treatment.
  • This appointment may take between two to four hours
  • If you are diabetic, please request a morning appointment
  • If you need to change your appointment, please phone booking office at 416-864-3044 or toll free at 1-800-263-2885.
  • If you have any questions or concerns about your treatment, please phone the Kidney Stone Centre at 416-864-3030.

You must make arrangements to be taken home by a responsible adult one hour after your treatment. You will be sedated during the treatment, and cannot go home on your own.

Before your treatment

Please see your urologist and/or your family doctor to arrange for the appropriate tests and review your medications.

1. Tests

Complete all the required tests below to ensure that your treatment is not delayed or cancelled.

  • Urine Culture – one to three weeks before your treatment (an untreated urinary tract infection may lead to cancellation)
  • ECG (Electrocardiogram) - one to three weeks before your treatment. Required if you have cardiac disease, arrhythmia, hypertension, diabetes on insulin, cerebrovascular disease  and/or serum Cr. >180
  • KUB (Kidney, ureter and bladder) X-ray – within one month of treatment
  • Non-contrast spiral CT scan or abdomen/ pelvic ultrasound – within one year before your treatment
  • Blood tests – if specifically ordered by the urologist or family doctor (especially for diabetics and patients taking diuretics/water tablets and/or the blood thinner, Coumadin)

Test results

  • Test results should be faxed by your doctor, in advance, to the Lithotripsy Unit at 416-864-3048.
  • If you had a CT Scan, Xray or Ultrasound test done outside of St. Michael’s Hospital, please bring a copy of the results on the day of your treatment. (A copy of your CT scan and Xray on a CD or a written report of a recent abdominal/pelvic ultrasound).

2. Check your medicines

  • Review all medications (over-the-counter, herbal, prescription, including topical, oral, inhalers) with your doctor or pharmacist to determine if any have a blood thinning effect.
  • If you are taking any medications that have a blood thinning effect, please check with your doctor if it is safe to stop before treatment and when to stop taking them. Do NOT stop taking these medications without first speaking to your doctor.
    Examples of blood thinners are:
    warfarin (Coumadin®), rivaroxaban (Xarelto®), dabigatran (Pradax®), apixaban (Eliquis®)
  • If you are taking any antiplatelet medications or medications that contain ASA or a non-steroidal anti-inflammatory (NSAID), please check with your doctor if it is safe to stop seven days before treatment. An exception is ticlodipine (Ticlid®) which requires 10 days.
    Examples of antiplatelet medications are: ASA (acetylsalicylic acid or Aspirin), clopidogrel (Plavix®), ticlodipine (Ticlid®), Aggrenox®, prasugrel (Effient®)
    Examples of non-steroidal anti-inflammatories (NSAID) are: ibuprofen (Advil®, Motrin®), indomethacin, naproxen (Aleve®), naproxen sodium (Anaprox®), Percodan®, ketorolac (Toradol®) or diclofenac (Voltaren®, Arthrotec®, Voltaren gel®, Pennsaid®).

If your doctor says that it is not safe for you to stop your blood thinners, antiplatelets or NSAIDs as described above, then please call the Kidney Stone Centre (at 416-864-3030) and your urologist.

Shock Wave Lithotripsy cannot be done if you have not stopped your blood thinners, antiplatelets or NSAIDs as instructed by your doctor before your treatment date.

  • If you are taking herbal supplements, stop these seven days before treatment. If they were prescribed, check these instructions with
    your doctor.
  • If you are diabetic: Do not take your diabetic medication or insulin the morning of your treatment but bring it with you to
    your appointment.
  • The following pain medications are OK to continue: acetaminophen or opiates. Examples of some of these medications are: Tylenol #1, 2, or 3, Morphine, Hydromorphone (Dilaudid), and Percocet.
  • If you take medication for high blood pressure, please take it as usual on the day of your treatment.
  • If your medication does not interfere with the treatment after checking with your doctor, you can take it as usual on the day
    of your treatment with a small sip of water.

3. Prepare yourself

It is important to prepare for your treatment. Remember to:

  • Arrange for someone to take you home after the treatment
  • Follow these instructions in this booklet for tests, medicines, food and drink
  • Delay any travel outside the country until the results of your treatment are checked (about one month after the treatment)
  • Bring all your medications (including vitamins, herbal medicines, ointments, lotions, sprays, inhalors, and any injectable medicines) in their original containers and a medication list from your pharmacy

Your treatment may be cancelled if you have not followed these instructions.

Watch this short video about shockwave lithotripsy. It shows what you can expect when you come for treatment at St. Michael’s Hospital.

The day before your treatment

What foods should I avoid?

For a better view of your kidney stone, do not eat gas-producing foods such as beans, broccoli, cabbage and carbonated beverages.

Also, please try to empty your bowels before your treatment.

On the day of your treatment

When do I stop eating and drinking?

  • You are allowed to eat solid food until midnight of the night before your procedure
  • On the day of your procedure no chewing gum and no candy.
  • You may drink one glass (250ml) of a clear liquid up until three hours before your check-in time.
    Examples of clear fluids: water, real or artificial fruit juices with no pulp, clear tea and black coffee with no milk or cream.
  • No carbonated or alcoholic beverages

What do I need to bring with me?

  • OHIP Card
  • A copy of your CT scan and X-ray on a CD or a written report of a recent abdomen/ pelvic ultrasound. Only needed if tests were not done at St. Michael’s Hospital.
    • To pick up your CD, go to the film library at the hospital where your CT scan was done.
  • The phone number of the responsible adult taking you home
  • Any medications that you are taking in their original containers and medications list from your pharmacy
  • 24-hour urine collection (if required)

Directions to the Kidney Stone Centre

This centre, including the Lithotripsy Suite, is located on the 5th floor of the Cardinal Carter Wing. Take the north Cardinal Carter Wing elevators up to the 5th floor. Please ask for directions at the information desk if you need help.

What can I expect when I arrive for my treatment?

  1. View a short video describing the treatment.
  2. Have an X-ray (KUB) before your treatment.
  3. Change into a hospital gown.
  4. Have an interview by a nurse, the anaesthetist and the urologist.
  5. In the treatment room, receive an IV (intravenous) in the arm or hand.
  6. The anaesthetist will give you some sedation through the IV. This medicine will keep you relaxed and comfortable through the treatment.

What happens after my treatment?

You will spend about one hour in the recovery room. We will offer you a sandwich and a drink.
You will also get:

  • Instructions about what to expect after your treatment
  • A follow-up appointment to assess the results of your treatment - it can be done here or with your own urologist

Going home after your treatment

After sedation, you will be fully awake but your thinking, memory and response time may not be normal.

You must arrange for a responsible adult to take you home after the treatment.

Do not drive a car or handle heavy machinery until the morning after your treatment.