Lithotripsy

Written by Dale Kiefer | Published on July 18, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

Overview

Lithotripsy is a medical procedure used to treat kidney stones. It may also be used to treat stones in other organs, such as the gall bladder or the liver. Kidney stones are collections of solid minerals that sometimes form in the kidneys. Healthy kidneys do not have these stone-like formations. Most stones pass out of the body naturally during urination.

Stones may consist of small, sharp-edged crystals, or smoother, heavier formations that resemble polished river rocks. Sometimes these larger formations do not pass in the urine. These stones can cause kidney damage. People with kidney stones may experience bleeding, pain, or urinary tract infections. When stones begin to cause these types of problems, your doctor may suggest lithotripsy in order to break up the stones.

How Lithotripsy Works

Lithotripsy uses sound waves to break stones apart. These sound waves are also called high-energy shock waves. The most common form of lithotripsy is extracorporeal shock wave lithotripsy (ESWL). Extracorporeal means “outside the body,” and in this case refers to the source of the shock waves applied from outside the body using a special machine.

ESWL was introduced in the early 1980s. It quickly replaced surgery as the treatment of choice for most stones. ESWL is a noninvasive procedure, because it does not require a surgical procedure. Noninvasive procedures are generally safer and easier to recover from than invasive procedures.

After lithotripsy, stone debris is removed from the kidney (s) or the tubes leading from the kidney to the bladder through urination. The lithotripsy procedure takes about 45 minutes to one hour to perform. Usually, the patient will be put to sleep with general anesthesia. Because of this, patients usually do not experience pain. Sometimes patients will be allowed to remain awake during the procedure and may even be allowed to follow the progress of the procedure on an ultrasound or X-ray monitor.

How to Prepare for a Lithotripsy

It’s important to tell your doctor about any drugs, over-the-counter supplements, or herbs that you may be taking. Drugs such as aspirin, ibuprofen, or blood thinners (such as warfarin) can interfere with the blood’s ability to clot properly. You will probably be asked to stop taking these types of drugs well before the procedure.

Do not stop taking any drugs you may have been prescribed unless the doctor tells you to do so.

You will likely be advised not to drink or eat anything at all for at least six hours and asked to arrive one to two hours before your procedure begins.

What to Expect During the Lithotripsy Procedure

Lithotripsy is usually done on an outpatient basis. This means you will report to the hospital or clinic on the day of the procedure, and probably leave the same day. After arriving for your appointment, you will be given drugs to sedate you and will receive antibiotics to fight infection. You will dress in a hospital gown and be asked to lie on an exam table on top of a water-filled cushion where you will remain while the lithotripsy procedure is performed.

Afterward, you will spend about two hours in recovery before being sent home, but some patients may be hospitalized overnight. You should plan to have a friend or family member drive you. Plan to spend one to two days resting at home after the procedure. It will be helpful if you drink plenty of water for several weeks after lithotripsy. This will help the kidneys flush out any remaining stone fragments.

Long-Term Outlook

Kidney stones can occur in the kidneys or in the ureters (the tubes leading from the kidneys to the urinary bladder). Stones can vary in size and what they’re made of. In most cases, lithotripsy completely removes the stones. Some patients may need more treatments, however. While lithotripsy works very well for most patients, stones may eventually recur.

Risks of Lithotripsy

Like most procedures, there are some risks involved in lithotripsy. Some patients may experience internal bleeding that will make a blood transfusion necessary. Some patients develop infections, while others may experience pain or even kidney damage from a stone fragment blocking the flow of urine out of the kidneys. The kidneys can suffer damage, and may not work as well after the procedure. Possible secondary complications may include high blood pressure or kidney failure.

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Article Sources:

  • Curhan, G. (2011). Nephrolithiasis. Cecil Medicine (24th ed., p. Ch. 128). Philadelphia: Saunders Elsevier.
  • D’Addessi, A., Vittori, M., Racioppi, M., Pinto, F., Sacco, E., & Bassi, P. (2012). Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them-a review. Scientific World Journal, 2012:619820. Retrieved June 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/22489195
  • Deem, S., Defade, B., et al. (2011). Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones. Urology, 78(4), 739-743.
  • Lingeman, J., Matlaga, B., & Evan, A. (2007). Surgical management of upper urinary tract calculi. Campbell-Walsh Urology (9th ed., p. Chapter 44). Philadelphia: Saunders.
  • Matlaga, B., Jansen, J., Meckley, L., Byrne, T., & Lingeman, J. (2012). Treatment of Ureteral and Renal Stones: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials. The Journal of Urology, [Epub ahead of print]. Retrieved May 15, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/22591962
  • Percutaneous urinary procedures – MedlinePlus. (n.d.). U.S. National Library of Medicine – National Institutes of Health. Retrieved June 4, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/007375.htm
  • Young, A., Ismail, M., Papatsoris, A., Barua, J., Calleary, J., & Masood, J. (2012). Entonox® inhalation to reduce pain in common diagnostic and therapeutic outpatient urological procedures: a review of the evidence.. Annals of The Royal College of Surgeons of England, 94(1), 8-11. Retrieved June 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/22524905

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