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Lithotripsy - Types, Indications, Risks, and Precautions

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Lithotripsy is a non-invasive procedure performed to remove large kidney stones. Read the article to know more.

Medically reviewed by

Dr. Manzoor Ahmad Parry

Published At October 18, 2022
Reviewed AtOctober 18, 2022

Lithotripsy is a non-invasive procedure followed to treat kidney stones that are too large to pass through the urinary tract. If the medications do not help to pass out the stones through the urinary tract, lithotripsy is followed to break down the larger stones into smaller ones to pass through the urine.

Lithotripsy was introduced in the early 1980s, which has changed the treatment modality and impact to a greater extent. Before introducing lithotripsy, patients had to undergo major surgical procedures to remove stones, but after the introduction of lithotripsy, the procedure was non-invasive, which means no cutting or insertion of telescopic machines was needed. It became the safest and most effective treatment option from then onward.

What Are the Types of Lithotripsy?

Different types of lithotripsy procedures are followed; they include :

  • Extracorporeal Shock Wave Lithotripsy (ESWL): This technique uses shock waves that create pressure on kidney stones and break them into smaller pieces. It is the most common lithotripsy procedure that is followed. This shock wave lithotripsy procedure helps reduce the pain and discomfort caused by kidney stones and helps avoid surgery to remove stones.

  • Electrohydraulic Lithotripsy (EHL): This type of lithotripsy uses shock waves to break down kidney stones so that smaller pieces can pass through the urinary tract. This procedure requires general anesthesia.

  • Ultrasonic Lithotripsy: The probe transmits high-frequency sound waves to the kidney stone, where the ultrasonic waves strike the stones without causing damage to the surrounding tissues and organs.

  • Laser Lithotripsy: Laser lithotripsy uses a pulsed dye laser of 540 nm (five hundred and forty nanometers) of light delivered through optical quartz fibers. The laser fragments the stone with a photoacoustic effect.

  • Endoscopic Lithotripsy: This type of lithotripsy uses visualization of calculus or stone in the urinary tract and simultaneous application of energy to break the stones.

  • Mechanical Lithotripsy: It is the most economical lithotripsy done by a pneumatic, mechanical device called lithoclast. This procedure is mainly used in managing larger and harder stones.

How Long Is the Lithotripsy Procedure?

The time taken for the lithotripsy procedure depends on the type of lithotripsy technique and the number of stones present. It ranges from thirty minutes to one hour. Usually, patients are discharged the same day after the procedure.

How Is the Treatment Procedure for Lithotripsy Conducted?

Lithotripsy is usually done in the hospital itself. This means the patient is required to visit the hospital or clinic on the day of the procedure. Before the procedure, they are made to change into a hospital dressing gown and asked to lie down on the examination table on a soft, cushioned pillow. This is where the procedure is performed. Sedation (anesthesia) and antibiotics are given to fight the infection. The strongest waves will pass through the body during lithotripsy and reach the kidney stones. Waves will break up stones into smaller particles that can be quickly passed out through the urinary system. After the procedure, the patient will spend about two hours recovering before being sent home. In some cases, they may be hospitalized overnight. Plan to spend one or two days relaxing at home after the procedure.

What Are the Indications for Lithotripsy?

Lithotripsy is indicated as follows :

  • When kidney stones are large and block urine flow and cause severe pain.

  • When an infection is developed.

  • When there is bleeding and pain.

  • Indicated when the stones are not too large and are seen on X-ray.

What Are the Advantages and Disadvantages of Lithotripsy?

Advantages :

  • Most of the stones are fragmented and can be passed through the urine.

  • It does not require long-term hospitalization. As a result, cost and recovery time are reduced.

  • Non-invasive and well-tolerated procedure.

  • Most of the stones can be treated safely.

Disadvantages :

  • A pre-procedural stent may be required in some cases and treated with extra pectoral shock wave therapy.

  • Results of larger stones may not be great in some cases compared to smaller stones.

  • Lithotripsy may require more than one session, depending on the number and size of the stones.

  • It cannot be done in patients with bleeding disorders and pregnant women.

What Are the Risks and Side Effects of Lithotripsy?

The possible risks or side effects that may be experienced after the procedure are:

  • People often experience bruises and pain after a lithotripsy wave shock.

  • Fever or chills may occur after the shock wave lithotripsy. This may indicate an infection, so one should talk to a doctor immediately.

  • Severe bleeding after lithotripsy may occur but is rare, and if it happens, the person might need a blood transfusion.

  • If pieces of stone are trapped, there may be a blockage in the ureter. Therefore, the doctor may perform an additional procedure with a ureteroscope to remove the fragments.

  • Chronic pain may indicate obstruction. And if a person has severe pain or does not get relief from taking pain medication, they should consult a physician.

What Precautions Should One Take Before Lithotripsy?

  • Clarify all queries and doubts with the physician without hesitating. It is better to be well-inormed about the procedure one will undergo and share fears or previous bad experiences with the doctor so that the doctor gets to know the patient better and can plan the procedure accordingly to be safe and successful.

  • Patients must inform the doctor if they are pregnant or suspect pregnancy, as the lithotripsy procedure is contraindicated in pregnancy since it may harm the unborn baby.

  • Notify the doctor in case of allergies to any medications, latex, or anesthetic substances.

  • Patients who are being treated for other diseases, taking blood thinners like Aspirin, or with a history of bleeding disorders should inform their doctor of the same.

  • Having a bystander along is ideal, as the procedure involves sedation, and it would be better to be driven back home.

Conclusion:

Even though lithotripsy is non-invasive and takes less time, the recovery time depends on the overall health condition, how well the patient follows the post-care instructions, and the number of stones present. The patient should be prepared to experience some pain because stones passing through urine can hurt. Doctors usually prescribe medications to reduce this pain. However, if it does not go away even after taking pain medication or the patient experiences symptoms like bleeding, fever, or chills, immediately seek the help of the doctor. Following the dietary recommendations and post-operative care procedures precisely can help prevent the recurrence of stones.

Frequently Asked Questions

1.

How Is the Lithotripsy Procedure Done?

 
 Lithotripsy is a procedure done to remove kidney stones. Here, high-energy shock waves known as radiowaves are targeted on the site of stones which breaks the stone into tiny fragments and thus gets flushed out of the body. It is a non-invasive procedure and is done under sedation.

2.

Why Is Pain After Lithotripsy?

 
 Lithotripsy is a painful procedure. The doctor recommends taking light sedation, a local or general, depending on the patient's choice. In some cases, the sedation given and the technique used depends on the individual's overall health and the type of stone.

3.

Is Lithotripsy Done When an Individual Is Awake?

Mostly, lithotripsy is done under sedation; during the procedure, the individual is asleep and pain-free. High energized shock waves are allowed to hit the stones, this is a painful procedure, and if awake, a tapping feeling may be felt. These high-energy waves break downs the stone into tiny pieces.

4.

What Is Better, Lithotripsy or Ureteroscopy?

Lithotripsy is a completely noninvasive procedure, while ureteroscopy is an invasive procedure. The success rate of ureteroscopy is a little higher than that of lithotripsy. Certain stones' success rate is higher with ureteroscopy than with high-energy shock wave lithotripsy.

5.

What Type and Size of Kidney Stone Require Lithotripsy?

 
Kidney stones less than 10 mm can be treated by lithotripsy. And for the stone s10 to 20 mm in size can also be treated along with it the location and composition are considered. Kidney stones that are larger than 20 mm are not treated through lithotripsy.

6.

How Long Does Stone Take to Pass After Lithotripsy?

 
Usually, during the procedure, the stones are fragmented into tiny pieces. These tiny fragmented pieces pass through the body soon after the procedure. it may take around four to eight weeks to completely leave the body and flush it out.

7.

What Happens if Lithotripsy Fails?

Some kidney stones are not affected by shock waves lithotripsy, and this procedure fails in treating them. In such cases, other alternative procedure is needed to remove stones.

8.

Is the Lithotripsy Procedure Painful?

High-energy shock waves are used in this procedure. These are also known are radio waves or sound waves. These waves hit the kidney stones and fragment them into pieces. This can generate pain though the procedure is non-invasive. Therefore the procedure is conducted under sedation

9.

How Long Does It Take To Get Recovered From Lithotripsy?

 Most individuals resume work within two days of the procedure. Recommended special diet is not required but consuming plenty of water helps in flushing out the fragmented stones. Pain is felt when the stone passes, and this can begin soon after the procedure and stay for four to eight weeks

10.

Is Lithotripsy a Major Surgery?

 
Lithotripsy is a non-invasive procedure.  And the individual can resume work within two days of the procedure. Lithotripsy is not a major surgery but requires sedation for the procedure and certain guidelines to be followed.

11.

How to Sleep After Lithotripsy?

After a lithotripsy procedure individual is recommended to drink around eight-ounce glasses of water in between intervals and sleep on the unaffected side of the site where the procedure is not done. This helps the affected kidney to stay elevated

12.

Who Is an Appropriate Candidate for Lithotripsy?

 
Individuals with large kidneystones, with both strictures and stones in kideny, and certain types of kidney tumors are appropriate candidates for lithotripsy. Also, children with the same conditions are appropriate candidates for lithotripsy.

13.

How Many Sessions of Lithotripsy Are Recommended?

Maximum of three sessions are required for successful lithotripsy. The individuals who undergo less than two sessions are excluded from analysis, and after the first session, urine samples are collected for analysis.

14.

When Is Lithotripsy Not Adviced?

 
Individuals with an increased risk of bleeding and who take blood thinners are not advised to undergo lithotripsy. As high-energy shock waves can lead to kidney bleeding, it is not adviced. It is also not adviced in individuals with a stone size of more than 2 cm, and if the stone is hard, narrowing the urinary tract, also individuals with obesity and other medical condition it is not advised.

15.

Is a Stent Required After Lithotripsy?

 
Usually, in lithotripsy, the ureteral stent is not required. In individuals with complications, it may be required. Not recommended and mandatory in individuals without any type of complications after lithotripsy for impacted ureteral stones and kidney stones.
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Dr. Manzoor Ahmad Parry
Dr. Manzoor Ahmad Parry

Nephrology

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