Lithotripsy

Lithotripsy is a technique used to break up stones that form in the kidney, bladder, ureters or gallbladder. Stones can cause obstruction, infection, prolonged bleeding or serious bleeding. There are several ways to remove these stones, although the most common is extracorporeal shock wave lithotripsy. The shock waves are focused on the kidney stone and break the stone into tiny pieces, which are passed out of the body naturally during urination. Throughout the procedure, the doctor can view what is happening to the stones through x-ray or ultrasound monitoring. 

This procedure prevents you from having to undergo surgery to have the stones removed which reduces discomfort, complications, hospital stay, costs and recovery time. Lithotripsy can cause mild discomfort so a mild sedative or painkiller is usually given beforehand. Depending on your level of sedation, you may feel a tapping sensation when the procedure begins. 

What You Need To Know

You will need to have routine blood and urine tests, x-rays and possibly an electrocardiogram before the procedure. X-rays will help the doctor determine if other treatment options or other treatments combined with lithotripsy are preferable because of the size, location or number of stones. Your urine may also be tested to exclude an infection, which will have to be treated prior to lithotripsy. 

You will usually be asked not to drink or eat anything for 6 hours prior to the procedure, or after midnight of the previous night if the procedure is in the morning. If you take regular medication, you should ask your doctor if they are safe to take before the procedure. For instance, you may be asked to stop taking aspirin and other drugs that interfere with blood clotting several days before. 

On the day of the procedure, you should wear comfortable clothes that are easy to remove, as you will have to change into a surgical gown. The procedure generally takes from 45 minutes to 1 hour. In most cases, you will be asked to lie on a table on top of a soft cushion, through which the shock waves are directed from the lithotripsy machine, called the lithotripter. 

Extracorporeal shock wave lithotripsy is a very safe procedure with few complications. However, minor complications do occur: 

  • For kidney stones, bleeding may occur around the kidney and in some rare instances, this may require a blood transfusion.
  • Sometimes, when kidney and urinary tract stone fragments are being passed, urine flow from the kidney can be blocked. If this causes severe pain or blockage of the kidney, a tube may be placed through the back and into the kidney to keep the kidney drained until all the fragments pass out.
  • Stone fragments are occasionally left in the body. This means that additional treatments are needed.

Note: An excessive urge to urinate, excessive blood in the urine, extreme pain or other unusual symptoms may indicate an infection or a blockage. If any of these symptoms occur, you must contact your doctor immediately. 

You should tell your doctor if you could be pregnant, because lithotripsy must not be performed during pregnancy. 

While most kidney stones are treated with this type of lithotripsy, not all stones can be treated this way. Sometimes a laser is used to pulverize the stone, but when a laser is used, the doctor must use an endoscope, which is a tube introduced into the body through the urinary tract to get close to the stone. 

The doctor may also access the stone from your back into your kidney, through a procedure called percutaneous lithotripsy. Laser lithotripsy is usually used when the stone does not respond to extracorporeal shock wave treatment or when it is in a place that is difficult to access. It requires a hospital stay and carries a slightly greater risk of complications than extracorporeal shock wave lithotripsy. 

After the treatment, patients usually remain in the recovery room for one and a half to two hours and are then discharged. You should go home and rest after discharge from the hospital, rather than attempting to get back into your daily routine. It is extremely important that you have someone drive you home from the hospital. Most people can return to normal daily activities within one or two days. 

For kidney and other urinary stones, it is recommended that you drink plenty of water in the weeks following the treatment, to help you to pass the stone fragments and prevent a recurrence. You may experience pain and nausea when the fragments pass, which begins soon after treatment and may last for up to four to eight weeks. Taking a painkiller and drinking lots of water will help relieve symptoms. It is normal to have a small amount of blood in your urine for a few days to weeks after the procedure. 

Depending on the type of lithotripsy, you may need antibiotics and anti-inflammatory medicines for a few days. If the stones are in your urinary system, you will probably be asked to strain your urine at home so any stones that are found can be sent to the lab for examination. 

You will be asked to visit your doctor for a follow-up appointment in the weeks following the lithotripsy. (For example, this might include a kidney x-ray to determine if kidney stones are still present). 

About 70 to 90 percent of patients who are good candidates for this treatment are found to be free of stones within a few months of treatment.