Lithotripsy
What is Lithotripsy?
Lithotripsy is a non-invasive or minimally invasive treatment used to break kidney, ureteric, or bladder stones into smaller fragments so they can pass naturally through the urinary tract or be removed more easily. The most common form is Extracorporeal Shock Wave Lithotripsy (ESWL), which uses focused shock waves generated outside the body. Other forms include laser lithotripsy, performed during ureteroscopy.
Lithotripsy is often recommended for stones that are unlikely to pass on their own but do not necessarily require open surgery. The most suitable treatment depends on the size, location, and composition of the stone, as well as the patient's overall health.
What are the Benefits of Lithotripsy?
Lithotripsy offers several advantages for appropriately selected patients.
Benefits include:
- Non-invasive treatment with ESWL, requiring no surgical incision
- Short procedure time
- Reduced pain and discomfort compared with more invasive surgery
- Usually performed as a day-case procedure
- Faster recovery and return to normal activities
- Lower risk of complications than open surgery
- Effective treatment for many kidney and ureteric stones
- Can reduce the need for more invasive stone removal procedures
When is Lithotripsy Recommended?
Your urologist may recommend lithotripsy in several situations.
It is commonly advised for:
- Kidney stones that are too large to pass naturally
- Ureteric stones causing pain or urinary obstruction
- Stones resulting in recurrent urinary tract infections
- Persistent blood in the urine caused by urinary stones
- Stones causing reduced kidney function or swelling of the kidney
- Patients wishing to avoid more invasive surgical procedures when appropriate
- Certain recurrent stone formers requiring treatment before complications develop
Not all stones are suitable for lithotripsy. Very large, hard, or unusually positioned stones may require ureteroscopy or percutaneous nephrolithotomy (PCNL).
What does Preparation for Lithotripsy Involve?
Before treatment, your urologist will arrange imaging studies such as an ultrasound, CT scan, or X-ray to determine the stone's exact size and location.
You may also require:
- Blood tests
- Urine tests to exclude infection
- Review of current medications, particularly blood-thinning medicines
- Instructions regarding fasting if sedation or anaesthesia is planned
If a urinary infection is present, it will usually need to be treated with antibiotics before the procedure.
How is Lithotripsy Performed?
During Extracorporeal Shock Wave Lithotripsy (ESWL), you lie comfortably on a treatment table while a machine delivers precisely targeted shock waves through the skin towards the stone. Ultrasound or X-ray imaging is used throughout the procedure to ensure accurate positioning.
The shock waves gradually fragment the stone into much smaller pieces. Depending on the stone, several thousand shock waves may be delivered over 30 to 60 minutes. Sedation or pain relief may be provided to improve comfort during treatment.
For stones unsuitable for ESWL, laser lithotripsy may be performed during ureteroscopy. In this procedure, a fine telescope is passed through the urethra and bladder into the ureter or kidney. A laser fibre breaks the stone into tiny fragments, which are either removed or left to pass naturally.
What to Expect during Recovery after Lithotripsy?
Most patients return home on the same day.
During recovery, it is common to experience:
- Mild discomfort or bruising around the treatment area
- Blood in the urine for a few days
- Passing small stone fragments over several days or weeks
- Temporary urinary urgency or discomfort
Drinking plenty of fluids helps flush stone fragments from the urinary tract. Pain relief may be prescribed while fragments pass. Follow-up imaging is usually arranged to confirm that the stone has cleared completely.
What are the Risks and Complications of Lithotripsy?
Although lithotripsy is generally safe, all medical procedures carry some potential risks.
Possible complications include:
- Blood in the urine
- Bruising around the kidney
- Pain as stone fragments pass
- Temporary blockage of the ureter by stone fragments (steinstrasse)
- Urinary tract infection
- Incomplete stone clearance requiring additional treatment
- Need for repeat lithotripsy or alternative stone removal procedures
- Rare injury to the kidney or surrounding tissues
Your urologist will explain the benefits and potential risks of lithotripsy and recommend the most appropriate treatment based on your individual circumstances.