Laser lithotripsy

Alternative names
Extracorporeal shock wave lithotripsy; Shock wave lithotripsy; Lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy

Description

Lithotripsy is a technique used to break up stones that form in the kidney, bladder, ureters, or gallbladder. There are several ways of doing this, 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.

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 medicines, 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. Older machines require that you immerse yourself in a specially designed tub filled with water, and although less commonly used, these machines are still available today and are effective.

Typically, you will receive some form of anesthesia, and depending on your level of sedation, you may feel a tapping sensation when the procedure begins. Since lithotripsy can cause mild discomfort, a mild sedative or painkiller is given beforehand.

You should tell your doctor if you are 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, via 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.

Indications

Lithotripsy is used to remove kidney, gallbladder, and other stones that have caused obstruction, infection, prolonged bleeding, or serious bleeding.

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 to 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.

Risks

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 patients, this may rarely 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.  
  • An excessive urge to urinate, excessive blood in the urine, extreme pain, or other unusual symptoms, may indicate an infection or a blockage, and if any of these symptoms occur, you must contact your doctor immediately.

Expectations after surgery

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

Patients usually remain in the recovery room for 1.5-2 hours after the procedure and are then discharged. You should go home and rest after you’ve been discharged 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.

Convalescence

Most people can fully resume 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, as this will 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 4-8 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.)

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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