Lithotripsy for Kidney Stones (Extracorporeal Shock Wave Lithotripsy)

(Extracorporeal Shock Wave Lithotripsy)

Definition

Lithotripsy is a nonsurgical treatment for stones in the kidney [2] and ureter. It uses high energy shock waves to break kidney [3] stones into tiny pieces that can be passed with the urine.

Kidney Stones

Parts of the Body Involved

Lithotripsy is performed on kidney [2] and ureter.

Reasons for Procedure

Lithotripsy is used to remove a kidney [2] stone that:

Is too large to pass
Causes constant pain [4]
Blocks the flow of urine
Causes an ongoing urinary tract infection [5]
Damages kidney [2] tissue
Causes constant bleeding
Grows larger

Risk Factors for Complications During the Procedure

A risk factor is something that increases your chance of having complications during your procedure. Risk factors for complications during lithotripsy for kidney [2] stones include:

Allergy to anesthesia [6]
Regular use of aspirin or other drugs that may affect blood-clotting
Obesity [7]
Skeletal deformities
Pregnancy (contraindicated)
Presence of a pacemaker
Presence of a dilated aorta ( aneurysm [8] )

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical exam
X-ray [9]
Blood and urine tests
IVP (intravenous pyelogram) [10] —an x-ray of the urinary system taken after the injection of dye
Spiral CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
MRI scan [11] —a test that uses magnetic waves to make pictures of structures inside the body
Instruct you to stop certain medications before surgery, including aspirin and other blood-thinning agents, to avoid abnormal bleeding

Anesthesia

In most cases, heavy sedation or general anesthesia [12] is used to help you remain still and avoid discomfort.

Description of the Procedure

You are placed on a table attached to the lithotripsy equipment. The area being treated will lie on top of a soft cushion or membrane through which the waves pass. Your doctor uses x-rays [9] or ultrasound [13] to locate the stone, then positions your body to target the stone. One to three thousand shock waves are passed through the stones, until they are crushed into pieces as small as grains of sand.

After Procedure

You will be moved to a recovery area where you will be encouraged to drink fluids and may be given fluids through an intravenous (IV) line.

How Long Will It Take?

The procedure is typically 45 to 60 minutes.

Will It Hurt?

Anesthesia prevents pain [4] during the procedure. Pain and discomfort after the procedure can be managed by oral [14] pain [4] medication. There will be some pain [4] and discomfort afterward from the passage of broken stones, and some bruising on the area treated.

Possible Complications

Blood in the urine
Bruising in the back or abdomen
Pain as the stone fragments pass
Need for additional treatments

Average Hospital Stay

If a hospital stay is required, it is up to 2 days long.

Postoperative Care

You will be instructed to drink plenty of water in the weeks after the procedure to help the stone fragments pass. You will be able to move almost immediately after the procedure, and you will likely be able to resume daily activities within 1 to 2 days. You may be prescribed oral [14] pain [4] medication to help manage pain [4] and discomfort.

Outcome

About 70% to 90% of people who have lithotripsy for kidney [2] stones are free of stones within three months of treatment. Patients with stones in the kidney [2] and upper ureter have the highest success with treatment. If fragments that are too large to pass persist after the procedure, they can be treated with lithotripsy again.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

Excessive urge to urinate or inability to urinate
Excessive blood in the urine
Pain between the ribs and groin as stones pass
Signs of infection such as fever and chills
Extreme pain [4]

RESOURCES:

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov [15]

National Kidney Foundation
kidney [16].org/">http://www.kidney [2].org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org/ [17]

The Kidney Foundation of Canada: Northern Alberta and the Territories Branch
kidney [16].ab.ca">http://www.kidney [2].ab.ca

References:

American Urological Association website. Available at: http://www.afud.org/ [18] .

Kidney stones in adults. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/stonesadult [19] . Accessed November 11, 2005.

Lithotripsy. National Kidney Foundation website. Available at: kidney [16].org/atoz/atozPrint.cfm?id=87">http://www.kidney [2].org/atoz/atozPrint.cfm?id=87 . Accessed November 11, 2005.

Wash PC, Vaughan ED, Wein AJ, Kavoussi LR, Novick A, Partin AW, et al. Campbell’s Urology . 8th ed. Saunders; 2002.

Last reviewed June 2007 by Miguel Antelo, MD [20]

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical [21] advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health [22] provider prior to starting any new treatment or with any questions you may have regarding a medical [21] condition.