Lithotripsy is a type of medical procedure. It uses shock waves or a laser to break down stones in the kidney, gallbladder, or ureters. The main types are extracorporeal shock wave lithotripsy (ESWL) and laser lithotripsy.
The remaining particles of small stones will exit the body when the person urinates.
In this article, learn more about what to expect during lithotripsy, how to prepare for the procedure, and the success rate.
It is common to develop stones in the kidneys, gallbladder, or ureters.
Sometimes, stones are small enough to leave the body during urination without a person noticing. However, large kidney or ureter stones can cause pain and block the flow of urine.
If stones do not pass, they can damage the kidneys and urinary tract. When medications do not help, a lithotripsy procedure can break the stones down into smaller pieces so that they can come out in the urine.
The two main types of lithotripsy are extracorporeal shock wave lithotripsy (ESWL) and laser lithotripsy. Laser lithotripsy is sometimes known as flexible ureteroscopy and laser lithotripsy (FURSL) because doctors use a tool called a ureteroscope.
Both procedures can help eliminate bothersome stones quickly and effectively. The type of treatment a doctor recommends will depend on a range of factors, such as the type of stones the person has and their overall health.
ESWL uses shock waves to break down stones.
During this procedure, a doctor will use a machine called a lithotripter to aim sound waves directly at the stones through the body.
The sound waves break down the stones into small pieces. They are designed to affect the stone, but they can also harm other tissues in the body if the doctor does not carefully administer and monitor them.
The procedure takes about 1 hour and usually happens in a hospital. In most cases, a person can go home the same day. After the treatment, they should pass the stone particles over several days or weeks through urination.
It is important to note that there can be complications with this treatment. One complication can be bleeding due to damage to the kidney.
This procedure involves using an endoscope to treat stones in the ureter. An endoscope is a flexible tube with a light and camera attached that helps a doctor see inside an organ or body cavity.
The doctor can see the stones using the ureteroscope and use a laser to break them down. The procedure takes about 30 minutes, and most people can go home the same day.
However, the procedure may take up to 2 hours depending on the number of stones the doctor needs to remove and their hardness.
The broken stone fragments should pass easily through urine in the days and weeks following the procedure.
The success of any one method will depend on stone composition, density, size, and location.
One systematic review found that FURSL had a success rate of
Before the lithotripsy procedure, a doctor will run tests to determine the number of stones a person has, as well as their size and location.
It is likely that the doctor will use a non-contrast CT scan to diagnose kidney stones because this test is highly sensitive and specific.
They will also use a standard abdominal X-ray known as a kidney, ureters, bladders (KUB) to find calcium-containing stones.
A person should let the doctor know if they are taking any medications in advance. Before the procedure, they may need to stop taking certain medications, including blood thinners and over-the-counter pain relievers such as aspirin and ibuprofen. This is because these can interfere with the ability of the blood to clot.
Blood clotting is essential to stop any bleeding that might occur during or after the procedure.
Lithotripsy usually takes place under general anesthetics, which means that the person will be asleep and will not feel any pain. Typically, people will need to fast for 8–12 hours before receiving anesthetics.
Anyone who is undergoing lithotripsy should also plan to have someone drive them home, as anesthetics can cause drowsiness and nausea for several hours after the procedure.
Once in the procedure room, the doctor will place an intravenous line in the person’s arm to administer anesthetics and provide pain medication.
For ESWL, the person will lie on the table with the lithotripter positioned to target the location of the stones.
The doctor will pass a water-filled cushion between the body and the lithotripter to conduct the shock waves properly. The shock waves are not painful.
The doctor may also place a stent in the ureter to help the broken stones pass.
For FURSL, a doctor will insert a ureteroscope into the bladder and up into the ureter and kidney if necessary. They will then use a laser to break down any stones they see.
After the person has woken up from the anesthetics, the doctor will monitor them for at least 1 hour to confirm that they are comfortable and stable enough to go home. The doctor will provide care instructions and pain medications before discharging them.
It may take a few weeks for the person to pass all the stone fragments, and it is not unusual for them to see blood in the urine for the first few days after the procedure.
It is also common to experience pain in the back and flank, but pain medications can reduce the severity of this pain. Some people may also experience mild bruising on the skin where the shock waves entered the body.
It may be over a week before a person feels able to return to work following a ureteroscopic procedure.
Side effects tend to be minor due to
However, full recovery may take longer than this for some people.
People often experience bruising and soreness after shock wave lithotripsy.
Fever or chills may occur after ureteroscopy and shock wave lithotripsy. These may indicate an infection, so a person should speak with a doctor if they experience fever or chills.
Heavy bleeding after lithotripsy is uncommon.
If stone fragments get stuck, there may be a blockage in the ureter. If this is the case, a doctor may perform an additional procedure with a ureteroscope to remove the fragments.
Prolonged pain may also indicate a blockage. If a person has severe pain or does not get relief from taking pain medications, they should contact a doctor.
Lithotripsy procedures cannot treat large or hard stones.
Also, ESWL may not benefit people obesity, as the shock waves may not be able to reach the stones.
Doctors do not recommend lithotripsy procedures for pregnant people, as they may pose a risk to the fetus.
Some stones will require more than one procedure, and, in some cases, a doctor may need to place a stent and remove it once the stone fragments have passed.
Lithotripsy uses shock waves or a laser to break down stones in the kidney, gallbladder, or ureters. There are two main types of lithotripsy — ESWL and FURSL — and the procedure usually lasts between 30 minutes and 2 hours.
If a person experiences fever or chills after undergoing ureteroscopy or shock wave lithotripsy, they should contact a doctor. These may indicate infection.