Lithotripsy





Definition

Lithotripsy is the use of high-energy shock waves to fragment and disintegrate kidney stones. The shock wave, created by using a high-voltage spark or an electromagnetic impulse outside of the body, is focused on the stone. The shock wave shatters the stone, allowing the fragments to pass through the urinary system. Since the shock wave is generated outside the body, the procedure is termed extracorporeal shock wave lithotripsy (ESWL). The name is derived from the roots of two Greek words, litho , meaning stone, and trip , meaning to break.


Purpose

ESWL is used when a kidney stone is too large to pass on its own, or when a stone becomes stuck in a ureter (a tube that carries urine from the kidney to the bladder) and will not pass. Kidney stones are extremely painful and can cause serious medical complications if not removed.


Demographics

For an unknown reason, the number of persons in the United States developing kidney stones has been increasing over the past 20 years. White people are more prone to develop kidney stones than are persons of color. Although stones occur more frequently in men, the number of women who develop them has been increasing over the past 10 years, causing the ratio to change. Kidney stones strike most people between the ages of 20 and 40. Once persons develop more than one stone, they are more likely to develop others. Lithotripsy is not required for treatment in all cases of kidney stones.


Description

Lithotripsy uses the technique of focused shock waves to fragment a stone in the kidney or the ureter. The affected person is placed in a tub of water or in contact with a water-filled cushion. A sophisticated machine called Lithotripter produces the focused shock waves. A high-voltage electrical discharge is passed through a spark gap under water. The shock waves thus produced are focused on the stone inside the person's body. The shock waves are created and focused on the stone with the help of a machine called C-Arm Image Intensifier. The wave shatters and fragments the stone. The resulting debris, called gravel, can then pass through the remainder of the ureter, through the bladder, and through the urethra during urination. There is minimal chance of damage to skin or internal organs because biologic tissues are resilient, not brittle, and because the shock waves are not focused on them.

The shock wave is characterized by a very rapid pressure increase in the transmission medium and is quite different from ultrasound. The shock waves are transmitted through a person's skin and pass harmlessly through soft tissues. The shock wave passes through the

Kidney stones that are too big to pass through the ureter become very painful (B). During lithotripsy, the patient is put in a tub of water, or on a water-filled blanket. Shock waves are used to break up the stone (C). These smaller pieces are able to pass out of the body (D). (Illustration by GGS Inc.)
Kidney stones that are too big to pass through the ureter become very painful (B). During lithotripsy, the patient is put in a tub of water, or on a water-filled blanket. Shock waves are used to break up the stone (C). These smaller pieces are able to pass out of the body (D). (
Illustration by GGS Inc.
)
kidney and strikes the stone. At the edge of the stone, energy is transferred into the stone, causing small cracks to form on the edge of the stone. The same effect occurs when the shock wave exits the stone. With successive shock waves, the cracks open up. As more cracks form, the size of the stone is reduced. Eventually, the stone is reduced to small particles, which are then flushed out of the kidneys or ureter naturally during urination.


Diagnosis/Preparation

ESWL should not be considered for persons with severe skeletal deformities, people weighing more than 300 lb (136 kg), individuals with abdominal aortic aneurysms, or persons with uncontrollable bleeding disorders. Women who are pregnant should not be treated with ESWL. Individuals with cardiac pacemakers should be evaluated by a cardiologist familiar with ESWL. The cardiologist should be present during the ESWL procedure in the event the pacemaker needs to be overridden.

Prior to the lithotripsy procedure, a complete physical examination is performed, followed by tests to determine the number, location, and size of the stone or stones. A test called an intravenous pyelogram (IVP) is used to locate the stones, which involves injecting a dye into a vein in the arm. This dye, which shows up on x ray, travels through the bloodstream and is excreted by the kidneys. The dye then flows down the ureters and into the bladder. The dye surrounds the stones. In this manner, x rays are used to evaluate the stones and the anatomy of the urinary system. Blood tests are performed to determine if any potential bleeding problems exist. For women of childbearing age, a pregnancy test is done to make sure they are not pregnant. Older persons have an EKG test to make sure that no potential heart problems exist. Some individuals may have a stent placed prior to the lithotripsy procedure. A stent is a plastic tube placed in the ureter that allows the passage of gravel and urine after the ESWL procedure is completed.

The process of lithotripsy generally takes about one hour. During that time, up to 8,000 individual shock waves are administered. Depending on a person's pain tolerance, there may be some discomfort during the treatment. Analgesics may be administered to relieve this pain.


Aftercare

Most persons pass blood in their urine after the ESWL procedure. This is normal and should clear after several days to a week. Lots of fluids should be taken to encourage the flushing of any gravel remaining in the urinary system. Treated persons should follow up with a urologist in about two weeks to make sure that everything is progressing as planned. If a stent has been inserted, it is normally removed at this time.


Risks

Abdominal pain is fairly common after ESWL, but it is usually not a cause for worry. However, persistent or severe abdominal pain may imply an unexpected internal injury. Occasionally, stones may not be completely fragmented during the first ESWL treatment and further lithotripsy procedures may be required.

Some people are allergic to the dye material used during an IVP, so it cannot be used. For these people, focused sound waves, called ultrasound, can be used to identify where the stones are located.


Normal results

In most cases, stones are reduced to gravel and passed within a few days. Individuals may return to work whenever they feel able.


Morbidity and mortality rates

Colicky renal pain is very common when gravel is being passed. Other problems may include perirenal hematomas (blood clots near the kidneys) in 66% of the cases; nerve palsies; pancreatitis (inflammation of the pancreas); and obstruction by stone fragments. Death is extremely rare and usually due to an undiagnosed associated or underlying condition that is aggravated by the lithotripsy procedure.


Alternatives

Before the advent of lithotripsy, surgery was used to remove kidney stones. This approach is uncommon today, but occasionally used when other conditions prevent the use of lithotripsy. Attempts are occasionally made to change the pH of urine so as to dissolve kidney stones. This treatment has limited success.

See also Cystoscopy .


Resources

BOOKS

Field, Michael, David Harris, and Carol Pollock. The Renal System. London: Churchill Livingstone, 2001.

Parker, James N. The 2002 Official Patient's Source Book on Kidney Stones. Logan, UT: ICON Health, 2002.

Tanagho, Emil A., and Jack W. McAninch. Smith's General Urology, 15th ed. New York: McGraw-Hill, 2000.

Walsh, Patrick C., and Alan B. Retik. Campbell's Urology, 8th ed. Philadelphia: Saunders, 2002.

PERIODICALS

Ather, M. H., and M. A. Noor. "Does Size and Site Matter for Renal Stones Up to 30 mm in Size in Children Treated by Extracorporeal Lithotripsy?" Urology 61, no.1 (2003): 212–215.

Downey, P., and D. Tolley. "Contemporary Management of Renal Calculus Disease." Journal of the Royal College of Surgery (Edinburgh) 47, no.5 (2002): 668–675.

Hochreiter, W. W., H. Danuser, M. Perrig, and U. E. Studer. "Extracorporeal Shock Wave Lithotripsy for Distal Ureteral Calculi." Journal of Urology 169, no.3 (2003): 878–880.

Rajkumar, P., and G. F. Schmitgen. "Shock Waves Do More Than Just Crush Stones: Extracorporeal Shock Wave Therapy in Plantar Fasciitis." International Journal of Clinical Practice 56, no.10 (2002): 735–737.


ORGANIZATIONS

American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. http://admin@afud.org. http://www.afud.org .

American Lithotripsy Society. 305 Second Avenue, Suite 200, Waltham, MA 02451.

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org .

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201-5559. (410) 727-1100. http://www.auanet.org/index_hi.cfm .

National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. (781) 895-9098. Fax: (781) 895-9088. E-mail: http://als@lithotripsy.org. http://www.kidney.org .

OTHER

Case Western Reserve University. [cited March 17, 2003] <http://www.cwru.edu/artsci/dittrick/artifactspages/b-2lithotrips .htm> .

Global Lithotripsy Services. [cited March 17, 2003] http://www.gls-lithotripsy.com/Howdoes.html .

Lifespan. [cited March 17, 2003] <http://www.lifespan.org/mininvasive/revised/patient/gallstones/l thotripsy.htm> .

National Institute of Diabetes and Digestive and Kidney Diseases. [cited March 17, 2003] <http://www.niddk.nih.gov/health/urolog/pubs/stonadul/stonadul.ht #whogets> .

National Library of Medicine. [cited March 17, 2003] <http://www.nlm.nih.gov/medlineplus/ency/article/007113.htm ; .


L. Fleming Fallon, Jr, MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Lithotripsy is performed by a technician or other individual with specialized training under the supervision of a physician. The physician in charge usually has specialized training in urology. Lithotripsy is most often performed as an outpatient procedure in a facility affiliated with a hospital.

QUESTIONS TO ASK THE DOCTOR


  • Is the doctor board certified in urology?
  • How many lithotripsy procedures has the doctor performed?
  • What is the doctor's complication rate?


User Contributions:

becki
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Apr 26, 2008 @ 7:19 pm
I am looking for research on acute hepatitis occuring after ESWL. My papapalegic daughter had ESWL treatment for a recoccuring stag horn and within 72 hours develped acute hepatitis.
ALBERTO
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Feb 6, 2009 @ 3:15 pm
already submitt ny info, have no idea why is coming back to me,
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Jul 28, 2010 @ 6:06 am
Hi,
Can ESWL treatment be given to aged women (> 55 yrs).
The size is more than 2 cm.
Please guide.
Regards,
Pradeep More
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Sep 22, 2010 @ 12:12 pm
I had the ESWL done on Monday, it is now wednesday, and I am having significant pain in my abdomin and flank area. My kidney stone was very large - 10MM. I have only passed a little bit of gravel, not even measurable. Is this normal? Should I be in so much pain after having 4 vic odin? I don't want to get liver damage from taking the vicodin, But I am in pain. Not sure what to do.
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Oct 5, 2010 @ 10:22 pm
Are there any lasting side effects of having multiple ESWL treatments? If so, what?
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Nov 15, 2010 @ 3:03 am
i am having the lithotripsy procedure in two weeks and would like to hear from anyone who has alredy had this procedure done as i am quite scared about having this procedure done. Please help, thank you so much.
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Nov 19, 2010 @ 1:13 pm
husband had kidney stone lithotripsy for the third time in 20 years stones size of golf balls or eggs. last surgery he now wets bed at night must use towels on bed EVERY NIGHT! cannot control urine while sleeping. I think DR. damaged a nerve. I called DR. he wanted husband to come back for ultra sound husband said no could not take anymore time off from work sooo now 3 yrs later still wetting bed at night ..I AM SICK OF IT NO SEX LIFE AT ALL ! CAN it be fixed at this point?
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Nov 27, 2010 @ 10:22 pm
i have chronic pancreatities with stones ,want to remove stones with tithotripsy.it is best or not.
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Jan 2, 2011 @ 12:12 pm
lithotripsy best treatment just for urinery stones ULS
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Jan 31, 2011 @ 8:20 pm
Hi, I am schudueled to have this Procedure on the 10th, I had a Tummy Tuck Last year, Since I feel Like these days the Healthcare is Not too Infomative bc of certain reasons, I need not mention.
Thsi Procedure cant Hurt me, I mean it is a Year, even tho I still feel Numb In areas and On My Abdomen?
Just wanted to Know.
Thanks Michele
Allison
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Feb 17, 2011 @ 12:12 pm
How much does this procedure cost?? I need a low cost in Utah, preferebly close to or in Provo, Utah
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Jun 12, 2011 @ 3:03 am
HI I MM ALSO THE PATIENT OF KIDNEY STONE THE SIZE OF BIGGEST STONE IS 1.7 CM AND MANY SMALL STONES I M 32 YRS OF AGE I M INTRESTED IN LITHOTRIPSY TELL ME ABT DIET B4 THIS TREATMENT I HAVE ALSO INFECTION IN MY LEFT KIDNEY I HAVE STONES ONLY IN LEFT KIDNEY PLZ REPLY ME THX ALOT KAHLID I
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Sep 4, 2011 @ 9:09 am
I HAD MY SECOND LITHOTRIPSY SURGERY. I1VE BEEN SCREENING URINE A LOT OF PIECES OF STONE HAVE BEEN COMING OUT. WHAT IF ALL OF THE STONES DON1T COME OUT DO I HAVE TO HAVE THE PROCEDURE AGAIN?
Nopal
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Oct 22, 2011 @ 7:19 pm
I had lithotripsy on Thursday for a 4.7 mm stone that was lodged in the kidney. I have been urinating with lots of blood. I haven't passed any sand or stone particles at all. Is this common? did it not work for some reason? can others share their stories on this since I can't seem to find any description of real life stories. thanks.
James Raymond
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Dec 1, 2011 @ 6:18 pm
can lithotripsy cause any damage when used, any side effects,what teats can i get to find if i have been damaged, where can i go for second opinion, in Boston Mass
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Jan 13, 2012 @ 2:14 pm
IT WAS 18 mm x 10 mm long stone (calcium oxalate) in my left kidney. I did lithrotripsy last week in Abu Dhabi at private hospital. first of all Doctor passed a stent from kidney to bladder to avoid the ureter blockage. after two days first sesssion of laser was held but that was painful, a small gravel was left so the second session needed to remove , was held after one week in this time remaining gravel was break and passed through stent without pain. last KUB Showed normal insize and no abnormility was found in the left kidney. I appreciated and a lot of thankful to my medical team to do it successfully because my weight was 140 kilogram.
Lori Wilkins
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Feb 15, 2012 @ 7:19 pm
I live in the Coeur d'Alene, Idaho area and currently have kidney stones. How do I find a medical center close to my location. I have been hospitalized three times for kidney stones and have had one lithotripsy many years ago. I am approximately 50 miles from Spokane, Washington - the closest large city to me.

Thank You!
deepika
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Feb 27, 2012 @ 5:05 am
hi iam have kidney stone of 13mm. Dr suggest me to lithotripsy.for me what doubt means in periods time it will be do or not?
Codi Safford
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Mar 1, 2012 @ 9:21 pm
I am a forty year old white female. I have had numerous kidney stones since I was sixteen. I have had around 20 lithotripsies in the last 24 years. I have changed diets, used everything I could imagine to treat this. I have been to numerous urologists through the years. The last removal I had was of 13 small stones in my right kidney. When the stent was removed I had stones crystalized on the outside of the stent. I recently went in because I was having major pain and had my gallbladder removed. At the time of the scan I had a 3mm stone that I have had in my left kidney for the past 3 years. Also, I had a reformation of of around 15 stones in both kidneys. I went to my general practitioner who after a review of my records, finally told me what my stones consisted of and put me on a low blood pressure medication. I dont have high blood pressure, 120/80, but she told me that if they had put me on the blood pressure meds years ago, I wouldnt have kept forming the stones. I owe 500,000 in hospital bills when I could of been taking a bp med for 12 a month. Any comments, advice, etc.?
Terri
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Jun 8, 2012 @ 4:16 pm
Just had lithrotripsy procedure and was in and out of the hospital 3 times in 3 weeks. This has been no ride in the park and I have had 2 children.
Marylou
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Jun 25, 2012 @ 1:01 am
I had the lithotripsy procedure done 4 days ago. I was in much pain but that got better as the days went on. My problem is the stent that the doctor inserted during the procdeure is slipping out. This is 2 inches of plastic tubing with a small plastic ring on the end hanging out of the ureter. I tried to push it back in. That was a no go situation and it hurt. So the tube and ring are hanging there. I called the doctor and spoke to his associate, who had no idea what I was talking about because he says the stent is in a coil shape and can't jsut slip out. Does anyone have any idea about what I should do untill the morning?
nik
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Nov 11, 2012 @ 10:22 pm
did anyone experience vaginal pain associated with the lithotripsy? is this just due to the stent placement?
mukunda maji
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Dec 22, 2012 @ 2:14 pm
i am a 30 year old man.i had lithotripsy on 2008.now a 0.7c.c stone shows in right renal.my docror told me for another lithotripsy...please it is harmful?
leslie
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Feb 4, 2013 @ 9:09 am
Ive had 2 lithotripsy treatments in the past month for a kidney stone in the left kidney which was 12 mm. One week after having stent removed (it was in for 3 weeks) I am now having severe back pain in right flank and can hardly function. Had xrays and ct scan. Showed nothing . Can lithotripsy cause back pain?
Prakash
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Mar 3, 2013 @ 10:10 am
Sir/madam,
My uncle is aged of 80 yers and he has 2cm stones in his kidney, can is it possible to remove through this lithotripsy treatment. or suggest me the treatment options.
sincerely
prakash
rebekah
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Jul 4, 2013 @ 2:14 pm
I had it done two weeks ago. The procedure its self probably wasn't so bad, i was asleep. A stent was put in place to help the pieces pass. what has passed as been a lot like silt. However, a piece of the stone ,19mm x 10mm was left behind after 2 hours of working on the rest. A lot of the pain and discomfort comes from the stent but a large portion comes from the kidneys bladder etc. being swollen. i still have a lot of bleeding a lot of pain. Sometimes enough to leaving me curled up crying and praying for the pain to stop. doctors are going to try to blast some more of it in 2 more weeks. while the procedure by it self isn't so bad the after effects have been for me extremely painful. i can't do much more than walk around the house and yard and only talk to my dog and horses. my quality of life right now sucks!
GUL
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Jul 11, 2013 @ 7:19 pm
I HAV CROSED FUSED ECTOPIA AND UPER POLE KIDNEY HAVE MULTIPLE STONES DOCTOR OF TRUST PASED ME PCNL TUBE AND REMOVED IT WITHOUT SLEEP ME AFTER 5 MONTHS DONE 5 TIMES LITHOTRIPSY . NOW SITAUATION IS THIS THAT STONE IS AVAIBLE MULTIPLE SIZE. PLEASE ADVISE ME THAT WHAT SHOULD I DO. LAST TIME ESWL 2 JUNE 13.
donny
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Aug 27, 2013 @ 7:07 am
im 48 m , having my third lithotripsy in 6 years. all to blast the same 9mm stone. the first treatment cut the stone down to a 7mm. didnt bother me until 2 yers later. so blasted it again. second treatment split stone into two 3.5 mm stones. doctor said they should pass. 2 years later went to er in severe pain .one of the 3.5mm was obstructing urine flow cause a rupture in kidney.
had a stent placed in to the drain kidney. so rupture could heal. having lithotripsy this week.having stint in is very uncomfortable. more tolerable if you keep your kidneys full of water. all i drink is water.luckily i havent made any more stones just this very hard one.
rose
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Oct 20, 2013 @ 9:09 am
I am fortumate. Had a 7mm stone blasted on Thursday. X-ray showed it disappeared. No pain from procedure. Passing stuff that looks like grains of salt. Bleeding very minimal. Even annoying sten painhas calmed down but i will be glad when that is out. I hate it
dawar khan
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Oct 22, 2013 @ 10:10 am
i have 5 stones in my kidneys.what should i do?age 27. married. male.
greg
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May 30, 2014 @ 10:10 am
Ive had 5 lithos an I am only 25 years old. Ive had both stents placed before I rather the one with a string.. ive had a total of 23 stones removed. I have never passed one. I just had my 5th litho yesterday an today I am not urinating any blood an stent is hurting alot. First 4 I urinated blood an fragments the first few days. Im a littke worried an would like to know has this happened to anyone else?
Pam Young
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Aug 29, 2014 @ 3:15 pm
Is anesthesia required for Lithotripsy procedures?

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