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Lithotripsy for kidney stones

 
Lithotripsy is a commonly used alternative to surgery for the treatment of kidney stones. The procedure works by focusing high-energy shock waves to break up kidney stones. Once broken up, the sand-like fragments pass out of the body in your urine. 
 
The full medical term for lithotripsy is extracorporeal shock wave lithotripsy (ESWL). "Extracorporeal" refers to the shock wave being generated outside of the body. The procedure is arranged through a urologist (a urinary system specialist doctor) after tests are carried out to determine patient suitability for the treatment.

Who is lithotripsy appropriate for?

Kidney stones are hard deposits of minerals that form inside the kidneys. The stones can also affect other parts of the urinary system as they pass through the urinary tract in the urine.
 
Lithotripsy may be recommended when a kidney stone is too large to pass on its own, or when a stone becomes stuck in the ureter (the tubes that connect the kidneys and bladder).

The decision whether to use lithotripsy is dependent on stone size, number, density, and location. Lithotripsy is usually not recommended for kidney stones more than 2cm in diameter. These stones may need to be surgically removed. Lithotripsy may not be appropriate if a patient has one of the following conditions:

  • Pregnancy
  • Aortic aneurysm 
  • Bleeding disorders
  • Significant obesity 
  • Severe skeletal abnormalities
  • Urinary tract infection.

The lithotripsy procedure

Lithotripsy may be done as a day-stay procedure or you may stay in hospital for a day or two. 
To ensure the patient remains still during the lithotripsy procedure an anaesthetic is given - either in the form of sedation or general anaesthetic.

To allow the shock waves to be transmitted through the skin a rubber pad covered with a special gel is placed against the skin. Using ultrasound or x-ray guidance, the shock waves are focused on the kidney stone and the lithotripsy machine is activated.
 
The procedure takes approximately one hour, depending on the size and number of kidney stones. 
 
Urinary systemIf the kidney stone or stone fragments are large, a small tube (stent) may need to be inserted into the ureter prior to lithotripsy. This is positioned via the urethra (the body's tube through which urine leaves your body from the bladder) using a telescopic instrument called an endoscope. The stent allows the fragments to pass from the kidney without blocking the ureter. The stent is  removed in an outpatient clinic at a later date.

Intravenous fluids may be given during and immediately after the procedure to help flush out the kidney stone fragments. Once you are able, you will be urged to drink plenty of fluid to assist in this process.

After the procedure

Often there is slight bruising and discomfort around the area where the shock waves have entered the body. Some discomfort may also be experienced as the stone fragments pass through the urinary tract. If a stent was inserted you may need to urinate more often than normal, and you may have discomfort due to the stent irritating the ureter and bladder.
 
In some cases, a course of antibiotics may be prescribed to help prevent infection. 

The degree of discomfort experienced following the procedure will vary between individuals and can be influenced by the size of the residual stone fragments and the duration of the procedure. Pain-relieving medications can help to reduce any discomfort experienced.
 
It is usual for blood to be present in the urine for a few days after the procedure. It is important to inform the urologist promptly if the blood in the urine does not resolve or worsens, a fever develops, difficulty with urination is experienced, or there is increasing pain.
 
Usually work and other normal activities may be resumed the following day, if you feel able. If a stent has been inserted, your urologist will advise when a return to work is appropriate. 

A follow-up appointment with the urologist is usually arranged for four to six weeks after the lithotripsy procedure. An x-ray or ultrasound scan may be taken prior to this appointment to see if the procedure has been successful in clearing the kidney stone. Large stones may require more than one lithotripsy treatment.
 
Patients who have undergone a procedure for kidney stones should be provided with information on kidney stone prevention.

References

Cleveland Clinic (2017). Shockwave lithotripsy (Web Page). Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/16582-shockwave-lithotripsy [Accessed: 15/04/20]
Grasso, M. (2018). Extracorporeal shockwave lithotripsy treatment and management (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/444554-treatment [Accessed: 15/04/20] 
MedlinePlus (2020). Lithotripsy (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/007113.htm [Accessed: 15/04/20] 


Last Reviewed – April 2020
 
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