Key takeaways
- Lithotripsy is a medical procedure that uses shock waves or a laser to break down stones in the kidney, gallbladder, or ureters. The stones can then pass more easily via the stool or urine.
- The two main types of lithotripsy for urinary tract stones are extracorporeal shock wave lithotripsy (ESWL), which uses sound waves from outside the body, and flexible ureteroscopy and laser lithotripsy (FURSL), which uses a laser inside the body.
- Success rates for lithotripsy vary depending on the size, location, and composition of the stones. While generally safe, potential risks include bleeding, infection, and the possibility of needing additional procedures.
In this article, learn more about what to expect during lithotripsy for stones in the urinary tract, how to prepare for the procedure, and the success rate.
Stones can develop in the kidneys, gallbladder, or ureters. Often, stones are small enough to leave the body without a person noticing. However, large kidney or ureter stones can cause pain and block the flow of urine.
If urinary stones do not pass, they can damage the kidneys and urinary tract. When medications are ineffective, a lithotripsy procedure can break the stones down into smaller pieces, allowing them to pass through the urine.
The two main types of urinary tract lithotripsy are extracorporeal shock wave lithotripsy (ESWL) and laser lithotripsy. Laser lithotripsy is sometimes known as flexible ureteroscopy and laser lithotripsy (FURSL) or intracorporeal lithotripsy.
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 of the urinary tract uses shock waves to break down stones from outside the body. It is a noninvasive procedure that is quick and typically involves sedation or light anesthesia, rather than general anesthesia.
During the procedure, a person will lie on a table with a lithotripter positioned to target the location of the stones. This is the machine that emits the shock waves.
The doctor will pass a water-filled cushion between the body and the lithotripter to conduct the shock waves properly. The sound waves break down the stones into small pieces.
The doctor may also place a stent in the ureter to help the broken stones pass.
The procedure typically takes 45 to 60 minutes and usually happens in a hospital. In most cases, a person can go home the same day. After the treatment, the stone particles should pass through urination over several days or weeks.
The waves are designed to affect the stone, but they can also harm other tissues in the body if the doctor does not administer and monitor them carefully. There is a small risk of bleeding due to damage to the kidney.
This procedure is more invasive and involves the use of an endoscope to treat ureteral stones. An endoscope is a flexible tube with a light and a camera attached that helps a doctor see inside an organ or body cavity.
While a person is under general anesthesia, a doctor inserts a ureteroscope into the bladder and up into the ureter, reaching the kidney if necessary. They then use a laser to break down any stones they see. They may also place a stent to widen the passageway.
Most people can go home when they can pass urine without difficulty. However, the procedure may take
The broken stone fragments should pass through urine in the days and weeks following the procedure.
The success of any lithotripsy method depends on stone composition, density, size, and location.
In many cases, ESWL effectively breaks up stones and has a
FURSL tends to have a higher immediate success rate than ESWL. It is capable of reaching stones that are difficult to pass, and it can help people who have tried ESWL but still have stones they cannot pass.
However, FURSL is more invasive and has a higher risk of complications.
Before undergoing the lithotripsy procedure, a doctor will conduct tests to determine the number, size, and location of the stones.
The doctor may 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, and bladder (KUB) to detect 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 medications such as aspirin and ibuprofen.
These drugs can interfere with the blood’s ability to clot, which is essential for stopping any bleeding that may occur during or after the procedure.
A doctor may advise a person to fast for several hours or overnight before the procedure. A person who undergoes anesthesia or sedation will need someone to drive them home afterward.
After the person has recovered from any anesthesia or sedation, healthcare professionals will monitor them to ensure they are comfortable and stable enough to go home.
The doctor will provide care instructions and pain medications before discharging them. They will also arrange for stent removal, if applicable, and follow-up scans to ensure that all stone fragments have passed.
After procedures for urinary stones, it is important to drink plenty of water. People may experience some side effects, such as pain or bleeding. Some people who undergo ESWL also experience mild bruising. Anti-inflammatory pain medications may help reduce symptoms.
After 1 to 2 days, people who had ESWL can often resume their usual activities. For FURSL, this can take up to 2 weeks. Full recovery may take longer than this for some people.
Some of the potential risks of lithotripsy include:
- pain
- bleeding
- infection
- kidney injury
- ureter scarring or strictures
- failure to remove all of the stones
- blockages
However, both ESWL and FURSL are effective and generally have a
After lithotripsy, contact a doctor immediately if any of the following develop:
- persistent bleeding
- fever or chills
- severe pain
- passing blood clots or stone pieces
- inability to urinate
These could be signs of complications that require urgent attention.
Lithotripsy procedures are often effective for smaller stones, but they have limitations.
ESWL is
- are pregnant
- have severe high blood pressure
- have conditions that affect blood clotting
- are taking blood thinning medications
ESWL may also not be the best option for people with severe obesity.
In contrast, people who are pregnant or have blood-clotting disorders can sometimes undergo FURSL if there is a need for it. However, if a person has a urinary tract infection, they will need to receive treatment for that first.
FURSL may not be suitable for someone if they:
- cannot undergo general anesthesia
- have narrow ureters – this may require a stent first
- have other anatomical differences that block the ureters
For larger stones, other medical procedures may be necessary.
Lithotripsy is suitable for people with urinary stones measuring less than 20 millimeters (mm). However, doctors may recommend trying to pass them naturally first if the stones are very small.
This depends on the type of procedure and anesthesia. Those having FURSL with general anesthesia for urinary stones will not feel anything until after the procedure, but people with ESWL may feel some pain during and after.
Lithotripsy uses shock waves or a laser to break down stones in the kidney or ureters. There are two main types of lithotripsy — ESWL and FURSL.
ESWL is less invasive and has a lower rate of complications, but FURSL has a greater chance of breaking down all of a person’s stones immediately. After both procedures, what remains of the stones will pass via urine.
A doctor can discuss which option is best, taking into account a person’s unique circumstances and preferences.