Types of Lithotripsy

There are different types of lithotripsy used to break down kidney and urinary tract stones based on stone size, location and patient condition.

• Extracorporeal Shock Wave Lithotripsy (ESWL): Uses shock waves to fragment stones from outside the body.
• Laser Lithotripsy: Performed with a ureteroscope and uses laser beams to break down stones.
• Ultrasonic Lithotripsy: Uses high-frequency sound waves and is often used during endoscopic procedures.
• Mechanical Lithotripsy (Lithoclast): A device with forceps or baskets mechanically crushes the stones during endoscopy.
• Percutaneous Lithotripsy: A minimally invasive procedure to remove large or complex stones through a small incision.

Key Takeaways

• Type of Procedure: Non-surgical or minimally invasive
• Duration: Typically 30 minutes to 1 hour
• Anesthesia Used: Local or general anesthesia
• Recovery Time: 1 to 2 days for most patients
• Success Rate: Up to 90% for small to moderate-sized stones

Indications of Lithotripsy Procedure

Lithotripsy indications are determined based on stone size, location, composition and patient health, ensuring an effective and non-invasive treatment approach. Lithotripsy procedure is recommended for:

• Kidney Stones Causing Pain: When stones lead to severe discomfort or renal colic.
• Obstruction in the Urinary Tract: Stones blocking urine flow, leading to swelling or kidney damage.
• Recurrent Urinary Tract Infections (UTIs): Stones contribute to repeated infections.
• Non-Responsive to Medicines: When stones do not dissolve or pass naturally with conservative treatment.
• Moderate-Sized Stones: Stones between 4mm and 20mm in size.

Preparing for the Lithotripsy Surgery

• Medical Evaluation: Your urologist will assess your medical history through imaging tests like CT scans to determine the size and location of the stones.
• Medication Review: Inform your urologist about any medicines you are taking, including prescription drugs and supplements. Some medications may need to be adjusted before the procedure.
• Hydration: Stay well-hydrated before the procedure, as this can help improve the effectiveness of lithotripsy.
• Fasting: You may be instructed to fast for some period before the procedure, particularly if general anesthesia is used.
• Anesthesia Discussion: Depending on the type of lithotripsy used, you may be administered general anesthesia, sedation or remain awake during the procedure.
• Clothing and Comfort: Wear comfortable clothing to the procedure and follow any specific instructions provided by your healthcare team.
• Coordination: Arrange for someone to accompany you to the procedure and to drive you home afterward, especially if you receive sedation or anesthesia.
• Communication: If you have any questions or concerns about the procedure, don't hesitate to communicate with your healthcare team.

What Happens During a Lithotripsy Surgery Procedure?

Here is the step by step procedure for the Lithotripsy Surgery;

• Positioning: You will be positioned on a treatment table, usually lying on your back. The treatment area will be carefully positioned in alignment with the lithotripsy device.
• Anesthesia: Depending on the type of lithotripsy used, you may receive general anesthesia, sedation, or remain awake during the procedure.
• Imaging: Imaging techniques, such as ultrasound or fluoroscopy, may be used to locate the stones within your urinary tract precisely.
• Shock Wave Delivery: The lithotripsy device generates shock waves, which are focused on the location of the stone. These shock waves are delivered externally through the skin.
• Stone Fragmentation: The shock waves travel through the body and break the stone into smaller fragments.
• Monitoring: The procedure is monitored using imaging to ensure the stones are being effectively fragmented.
• Post-Procedure Evaluation: After the procedure, your healthcare team may perform imaging to assess the success of stone fragmentation.

Benefits of Lithotripsy

• Non-invasive or minimally invasive alternative to surgery
• Quick procedure with minimal recovery time
• High success rate for treating small to medium-sized stones
• Reduces or eliminates symptoms like pain, bleeding and obstruction

Lithotripsy Side Effects and Complications

While lithotripsy is a safe and non-invasive procedure, it may involve some risks and complications:

• Mild bleeding or bruising at the treatment site
• Blood in the urine for a few days
• Painful urination or discomfort
• Incomplete stone removal or recurrence
• Ureteral injury or infection
• Urinary tract blockage

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Recovery After Lithotripsy Surgery Procedure

Most patients can resume daily activities within a day or two, although strenuous activity should be avoided for a few days. You may notice blood in the urine, discomfort while urinating or the passage of stone fragments for several days. Pain relievers and increased fluid intake are usually recommended to ease recovery and increase stone passage.

Lithotripsy Aftercare

• Observation: If sedation or anesthesia was used, you'll be observed in a recovery area until you're awake and stable.
• Pain Management: You may experience some discomfort or mild pain after the procedure. Your healthcare team will provide pain relief instructions.
• Hydration: Drinking plenty of water helps flush out the stone fragments from your urinary system.
• Physical Activity: Light physical activity can help promote the passage of stone fragments. However, avoid strenuous activities initially.
• Follow-Up: You will likely have a follow-up appointment with your urologist to assess the success of the procedure and monitor your recovery.
• Passing Stone Fragments: Over the following days or weeks, you may pass stone fragments in your urine.
• Diet: Reduce intake of foods high in oxalate, like spinach and chocolate, and limit sodium and animal protein intake. Consult your urologist for dietary recommendations.
• Citrus Fruits: Incorporate citrus fruits that contain citrate, which may help prevent stone formation.