Lithotripsy Health Article

Definition

Lithotripsy is a medical procedure that uses shock waves to break up stones that form in the kidney, bladder, ureters, or gallbladder.

Alternative Names

Extracorporeal shock wave lithotripsy; Shock wave lithotripsy; Laser lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy; ESWL

Description

There are several forms of lithotripsy. The most common is extracorporeal shock wave lithotripsy (ESWL). Extracorporeal means outside the body.

You will usually be asked not to drink or eat anything for several hours before the test. Before the test is scheduled, tell your health care provider about any medicines you take. You may be asked to stop taking aspirin, ibuprofen, coumadin, and any other drugs that interfere with blood clotting several days before. You should tell your doctor if you are pregnant, because lithotripsy must not be performed during pregnancy.

You will wear a medical gown and lie down on an exam table on top of a soft, water-filled cushion. (Older machines required the person to sit in a tub filled with water. Although this isn't done much anymore, the method works, and some machines are still available today.) Since lithotripsy can cause mild discomfort, you will be given a mild sedative or painkiller before the procedure starts.

The health care provider will use x-ray or ultrasound images to see where the stones are. High-energy shock waves, also called sound waves, pass through your body to the area on the kidney stones. You may feel a tapping sensation when this starts. The waves break the stones into tiny pieces. It is easier for smaller pieces to pass out of the body during urination.

The procedure generally takes from 45 minutes to 1 hour.

ESWL is an alternative to surgery that is sometimes needed to remove stones from the kidney or ureter. Because ESWL requires no cutting, you have less pain and a quicker recovery. An overnight hospital stay is usually not needed.

While most kidney stones are treated with ESWL, not all stones can be treated this way. Sometimes a laser is used. When a laser is used, the doctor must use an endoscope, which is a tube introduced into the body, via the urinary tract, to get close to the stone. This usually requires general anesthesia (asleep, no pain), but you may go home the same day. Laser lithotripsy may be done if stones do not go away with ESWL, if they can't be treated with ESWL, or if you can not have ESWL for some reason. Laser lithotripsy carries a slightly greater risk of complications than extracorporeal shock wave lithotripsy.

The doctor may also access the stone from your back into your kidney, through a procedure called percutaneous lithotripsy. This is a more complicated procedure, and is only used for large kidney stones.

Indications

Lithotripsy is used to remove kidney, gallbladder, and other stones that have caused or may cause blockage, infection, or bleeding.

You will need to have blood and urine tests, x-rays, and possibly an electrocardiogram before the procedure. X-rays will help the doctor to determine if there are other treatment options, or if you will need additional treatments combined with lithotripsy.

Risks

Lithotripsy is generally safe. However, as with any medical procedure, complications can occur. Those related to lithotripsy include:

• Pieces of stone are left in the body. You may need more treatments.
• Bleeding around the kidney which, in rare cases, may require a blood transfusion.
• Damage to the kidney tissue or nearby structures in the stomach area may occur from ESWL. Some patients are at greater risk than others.
• Blockage of urine flow from the kidney due to pieces of stone. If this causes severe pain or blockage of the kidney, a tube may be placed through your back and into the kidney to keep the kidney drained until all the fragments pass out. Sometimes, a thin mesh tube called a stent is placed into the body (from the kidney to the bladder) before ESWL to prevent this from happening. A stent is usually put in the body after laser lithotripsy.

Signs of infection or blockage may include:

• Strong need to urinate
• Too much blood in the urine
• Extreme pain

Contact your health care provider if you have any of these symptoms.

Whether or not ESWL causes or leads to the development of high blood pressure and diabetes remains controversial. You may want to ask your doctor about this before having the procedure.

Expectations after surgery

How well a person does depends on the number, size, and location of the stones. However, lithotripsy completely removes stones in most patients who have the procedure.