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Hi everyone. Due to my work in Urology field nowadays at Royal Bangkok hospital, Cambodia, face many patients with frequently asked questions so I am thinking about writing some Urologic tips that is also launched in Royal Phnom Penh official website https://royalphnompenhhospital.com/

I will put it here and hopefully will be valuable for someone who seek for Urologic help. If you guys seem it is good, I will keep updated new tips every 2 weeks. I am open-mind for any discussions. I am not sure that "General Chatter" is matched with my content or not? please advise.

4th Generation ESWL, Really better than the old generation one?

Now days, every modern surgeon aims to do every operation as non-invasively as possible. In the past, kidney stones had be done by open surgery, Luckily right now we have several methods to get rid of the stone without any wound or minimising the wound. ESWL is one option for stone management we are going to talk about. The first ESWL machine was invented in Germany after World War 2. With the benefits of shockwave sound that can infiltrate into skin without any wound, it has been developed into the 4th generation machine which does not need to be done under anaesthesia so the patient can save on unnecessary expenses in terms of the anaesthesiologist team, operative cost and hospital stay.

1st Generation ESWL machine is really big, being the size of around a big truck and the patient needed to be operated on under a full-filled water tank. Definitely, needed the anaesthesia within the water so everything was difficult and nearly impossible to do.

That’s why 2nd generation ESWL machine was invented to solve the problem of staying in a water tank for a long time. With this generation ESWL, the first ever-dry technique, the patient tended to be more comfortable during the procedure. But the cons still exist, for example, the machine was still big, the patient was still not comfortable and needed anaesthesia due to the pain.

Commonly practiced all over the world right now, the 3rd generation ESWL machine is a lot more compact, more comfortable for the patient-allowing them lie down on the bed during operation. However, anaesthesia is still needed due to some shockwave pulse possibly missing the target and causing kidney pain.

Royal Phnom Penh hospital is the first and currently only hospital in Cambodia that has installed this technology. Even in Thailand most ESWL machines are still the previous 3rd generation that need to do shockwave under anaesthesia.

From the original paper from Taiwan, 4th generation ESWL reach 98.5% compared with 3rd generation one at 82.6% shockwave hit rate. The less missed target, the less pain patient will be experience. The pain is minimal so there is no need for any anaesthesia or even pain killers. The 12 mm of stone disappeared at 80% stone free rate within 3 months following up as reported.

With more than 1 year of experience in this machine, our success rate is varied among the stone size,
92% for less than 1 cm kidney stone
73% for 1-2 cm kidney stone
60% for more than 2 cm kidney stone

Strong patient satisfaction with no serious complications so far. Anyway, there are alternative management for the kidney stone and every procedure has pros and cons. The distinctive pro for 4th generation ESWL is day-care management and it is the least invasive for stone management. Is it worth to try before doing any harmful operation? Any questions you can come to visit me at the Urology clinic.

Youtube presentation on 4th ESWL in Khmer soundtrack with English subtitles
https://youtu.be/_82GEpmhhfg

Dr. Soarawee Weerasopone
Minimally invasive Urologist
Royal Bangkok hospital

I love it when doctors say the pain is minimal. Unless you have experienced it you cannotreally comment. Cambodians routinely have dental work doen without aneasthesia but as a soft westerner there is no way i could tolerate that. I think the big queation is how much do i save? i would rather have the 3rd gen machine and aneasthesia unless their was a big cost saving

Dr Pommy wrote: ↑Mon Feb 10, 2020 8:52 pm I am not sure that "General Chatter" is matched with my content or not? please advise.

Agreed. It will get lost in General Chatter. Moved you to Ask The Expats.

this statement does not exactly tell me you all know what ur doing? I'll be getting all medical in Thailand,
thank you

"However, anaesthesia is still needed due to some shockwave pulse possibly missing the target and causing kidney pain."

pczz wrote: ↑Tue Feb 11, 2020 3:27 am I love it when doctors say the pain is minimal. Unless you have experienced it you cannotreally comment. Cambodians routinely have dental work doen without aneasthesia but as a soft westerner there is no way i could tolerate that. I think the big queation is how much do i save? i would rather have the 3rd gen machine and aneasthesia unless their was a big cost saving

I experienced it and I can comment. The pain was tolerable and so was the price.

armchairlawyer wrote: ↑Wed Mar 11, 2020 7:26 pm

pczz wrote: ↑Tue Feb 11, 2020 3:27 am I love it when doctors say the pain is minimal. Unless you have experienced it you cannotreally comment. Cambodians routinely have dental work doen without aneasthesia but as a soft westerner there is no way i could tolerate that. I think the big queation is how much do i save? i would rather have the 3rd gen machine and aneasthesia unless their was a big cost saving

I experienced it and I can comment. The pain was tolerable and so was the price.

pain is relative. i went ot the dentist a month ago for a filling. To my horror he started the drill up without giving me anaesthetic. When i demanded novacaine he sai d":thank god. i hate doing stuff with no anaesthetic but khmer mostly refuse it" they obviously find the pain tolerablebut i certainly dont

Back to the main point about the 4th generation machine, it has a high hit rate on the stones, so the patient can endure a longer session with more shots in total and, with the higher hit rate, an even higher number reaching the target. Looking at the 3rd generation user websites from USA hospitals, it is normal to see 2,000 shots per session. At the Royal PP, I had 6,000 shots in one session. That means the patient pays for less sessions. There is less risk of shots missing the target and hitting the kidney, and less need for pain relief. Because anaesthesia is not required, the patient saves on extra fees. This is all good, and it is superb that PP has such an advanced piece of medical kit.
I guess if a patient has a really low pain threshold, he can have anaesthesia if he wants. For me, it was not a problem and I fell asleep a couple of times. The (all Thai) staff in the treatment room had good English and were highly competent.

That's not a tip, that's a way to get money out of people after the event & no advice on preventing reoccurrence. Prevention is better than the Cure as they say, although I quite like Robert Smith's earlier material, but I digress ...

And as a "Pommy", here's the NHS advice on preventing kidney stones in the first place:

NHS.uk wrote:The best way to prevent kidney stones is to make sure you drink plenty of water each day to avoid becoming dehydrated.

To prevent stones returning, you should aim to drink up to 3 litres (5.2 pints) of fluid throughout the day, every day. (edit: more in tropical climate)

You're advised to:

- drink water, but drinks like tea and coffee also count
- add fresh lemon juice to your water
- avoid fizzy drinks
- do not eat too much salt

Keeping your urine clear helps to stop waste products getting too concentrated and forming stones.

You can tell how diluted your urine is by looking at its colour. The darker your urine is, the more concentrated it is.

Your urine is usually a dark yellow colour in the morning because it contains a build-up of waste products that your body's produced overnight.

Drinks like tea, coffee and fruit juice can count towards your fluid intake, but water is the healthiest option and is best for preventing kidney stones developing.

You should also make sure you drink more when it's hot or when you're exercising to replace fluids lost through sweating.

I wanted to form a band named Prevention. At least people would say we were better than the Cure. (Edinburgh Festival joke)

Dear all,

Thank you so much for all comments. I will launch Topic on kidney stone prevention from your advice and hopefully can be some benefit.
I am doing personal Blog for giving some information on Urology field. my latest article on COVID-19 in Urology aspect.

https://thaiuroincambodia.com/2020/05/0 ... erasopone/

My homepage

https://thaiuroincambodia.com/