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Urolithiasis is formation of calculi at any
part of the urinary system. Globally about one to fifteen percent of people are
high risk for kidney stones at some period in their life (Morgan, and Pearle, 2016). In
2013, 49 million cases occurred (Naghavi, et al.,
2014), resulting in about
15,000 deaths (Vos et
The most painful urinary disorders among Egyptian older adults are Urinary
calculi. It is represent about forty five percent of urological hospital
admissions annually and approximately about 800,000 older patients were
diagnosed and hospitalized with renal calculi (El-Sharqawy and Ewis, 2002).
The objective of nephrolithiasis calculi management among the patients is to
achieve high rate of calculi clearance with less complications to the patients.

to the advent of SWL in 1980, the open surgery was only the available therapy for
large stone that could not pass with the urine to outside the body. Since then,
ESWL has become the first line of treatment and preferred technique by
urologists for renal and ureteral stone. Works best with stones in the upper
ureter between 0.4mm and 2 cm in diameter (Hayes et al., 2015).
SWL can be an effective treatment for 80 to 85% of simple kidney
(Miller &Lingeman, 2007).  It is an effective procedure for managing
85-90% of upper urinary tract stones.   WSL has several advantages when compared with
open surgery and endoscopic procedures, SWL need to fewer anesthesia, is
outpatient procedure, less invasive, and easy to performed and had less complications
rates (Haecker & Wess, 2010; Chandhoke, 2007).  Nevertheless, occasional side effects such as
hematoma, petechial bleedings, interactions with cardiac rhythm etc. are

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SWL is a method by which urinary calculi are broken
down into small fragments. The shock-waves produced by the machine are cautiously
focused on to the area under direction of the ultrasound or x-ray imagine. The
waves pass through tissues without causing permanent damage and destroy the
stone into small pieces like sand. Then, these pieces will go outside the body in
the urine over a period of time. It is the most commonly procedure used to
treat the stone in all sizes and locations. It is more successful in treating renal stones less than 2.5 cm in size, proximal
ureter stones and distal ureter stones ranged from 0.4 to2 cm (AL-Hakary et al., 2016; Urology, O. and Mohd et al.,

ESWL is a noninvasive surgical procedure. Hospital anxiety and surgery fear
are common among the most of patients, especially for the patient who has no previous
experience. But some people become so anxious and these normal fears turn into Claustrophobia from the procedure
(Aman, 20013).  Anxiety
has been associated with several pathophysiological responses such as
hypertension and dysrhythmias,
elevated temperature, sweating, nausea. It may cause constriction
of blood vessels, which result in difficulty in obtaining blood, so the
severe pre procedure anxiety may affect postoperative outcome (John,

The patients who feel anxiety about the
surgery should be express their fears to health care
team; this is often beneficially for patients
who having high-risk surgery. The nurse
and other health team must play an active role in reassuring and managing
anxiety by advising the patient to trust on himself and his surgeon and give
him full information about the nature of procedure, preoperative preparation,
anesthesia methods, and ideal behaviors during postoperative management (Aman,
20013 6; Pritchard, 2009). The family should be included
in psychological preoperative care to maximize feeling of patient security. The
good physical and psychological preparation for patients and their families’ in
preoperative course help them to do well in managing the patients in postoperative
phase (Townsend &
Beauchamp et al., 2015.)

 Teaching and education before surgery can help
in reduction of expected problems through giving of anticipatory information about
necessary preparations. It directly affects the safety of patient and became
part of the standard care that the Joint Commission focused on (The Joint
Commission. Ambulatory Health Care: 2011). Preoperative teaching must meet
the patient’s need for information related to the surgical procedure, which may
help in alleviating most of his or her fears, and improve surgical outcome (Lubin et al., 2013).

Patients must be
educated about management of postoperative pain. They should be advised to ask
the analgesic before the pain become severe. They are taught about rating their
pain on pain scale. This will help the health care team in evaluating degree of
their pain. They are also taught about none pharmacological strategies to control
the pain. (wicker
&Neill, 2010).

There are a very few researches about the effect
of education on patient knowledge, anxiety level, claustrophobia and
postoperative pain,  so the current study
examine the effect of pre-procedure teaching module for patients
undergoing  first session of shock wave lithotripsy
on  anxiety levels, pain perception, and

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