Patient’s name______________________ date of treatment_______________ time___________

Pre-ESWL Patient Instructions
Patient’s Name______________________ Date of Treatment_______________ Time___________ 1. If you develop symptoms of fever, cold, or sore throat before your treatment, please notify your physician. 2. Between 3 P.M. & 6 P.M. of the day before your treatment you may need to take an oral laxative, such as Dulcolax tablets, Ex-Prep Liquid or Magnesium Citrate. You should drink a minimum of 4-6 glasses of
water after taking the laxative. Eat a light evening meal. Do not eat or drink anything after 12:00
midnight. The morning of your treatment your physician may have you use a Fleets Enema, be sure to
check with your physician. Both the enema and the oral laxative may be purchased at your pharmacy.
3. REMEMBER, do not eat or drink anything after 12:00 midnight the night before your treatment.
4. Shower or bathe thoroughly before your treatment.
5. Do not ingest any alcohol for 24 hours before your treatment. 6. Please hold aspirin, aspirin compounds, and anti-arthritic medications for one week prior to your treatment. In addition, those taking Persantine, Coumadin and Plavix must notify us so that special arrangements with your medical doctor can be made regarding this medication. 7. Heart medications, blood pressure medications, and anti reflux medicines should be taken with a small amount of water on the day of your treatment. Diabetic medications should be held on the day of your treatment – please talk with your primary physician so he is aware and can adjust your dosage if necessary. If you test for blood sugar, please do so before your appointment. 8. Please do not bring money or valuables with you. 9. Please report on time on the date and time given to you. If you arrive late, your appointment may be rescheduled. Also, please leave your current phone number with your Urologist’s office so you can be reached if the schedule changes. 10. Wear Loose-fitting clothes (no panty hose, tight jeans, girdles, etc.) 11. Make arrangements for a family member or friend to drive you home after your treatment. YOU WILL
NOT BE ALLOWED TO DRIVE.
12. For most procedures, plan to stay approximately 1 ½ to 2 hours; your stay may be shorter or longer. 13. Please do not bring more than 2 (two) people with you. 14. You should have a responsible adult with you for the first 24 hours after your treatment. 15. You will need a thermometer to check your temperature for the first 24 hours after your treatment. 16. Your back may be sore after your treatment. Use ice intermittently for the first 24 hours, then heat as needed. If you do not have a heating pad, you may want to purchase one. 17. If you have any questions regarding these instructions, or develop any unexpected complications after the
procedure, please notify your physician. If you have unexpected complications, you may need to be admitted to a hospital. 18. You may need an X-Ray (KUB) before your procedure. Bring your films with you. 19. Check with your medical physician for medical clearance, if needed.

Source: http://www.northernlitho.com/forms/Pre_ESWL_Instructions.pdf