Lithotripsy | Treatment

Treatment

Next, the treatment is started. Depending on whether you are sedated or anesthetized, the power level and frequency of pulses are brought up slowly or more rapidly. The shock waves pulses create several different types of forces on the stone that combine to fragment it. The procedure usually takes an hour, but can go longer depending on the stone being fragmented. The picture on this page shows a visualization of the shockwaves converging on a kidney stone.

Post Treatment

After the treatment, a stent may be placed to expand your ureter and make it easier for the newly fragmented stone to pass out of your body. It may take up to a week for the fragments to pass, and they may cause some mild pain and blood in the urine when they are passed. Your doctor may encourage you to drink as much water as you can to help pass the pieces, or void through a screen to capture the pieces for analysis.

There can be complications as a result of ESWL. These include damage to nearby blood vessels and kidney tissue, which in rare cases can impair function of your kidneys. The risks of the procedure should and will be discussed in detail by your urologist.

Intracorporeal Lithotripsy

Advances in ureteroscopy have allowed better access through the ureter for kidney stone treatment. Most stones in the upper urinary tract can be treated with ESWL. However, certain stones are poor candidates for ESWL, as mentioned above, and require intracorporeal treatment.

For small stones, an endoscopic basket or grasping device can be used to remove a stone. However, larger stones require some fragmentation before they can be safely removed. To accomplish this, four techniques can be used for intracorporeal lithotripsy.

Laser Lithotripsy

Laser lithotripsy uses a holmium:YAG laser to vaporize kidney stones. This technique can fragment all types of kidney stones, and represents the most effective, safest, and most versatile intracorporeal technique available to urologists today. As with all intracorporeal techniques, a ureteroscope is first placed. Then, fibers of different sizes can be placed through the endoscope to reach the stone. Large fiber cores are used for the ureter and bladder, while small core fibers can be used to reach the kidneys.

Electrohydraulic Lithotripsy

Electrohydraulic lithotripsy (EHL) uses two electrodes to produce a spark that creates a shockwave to break apart the stone. EHL uses small, flexible probes that can reach stones throughout the entire upper urinary tract. Its disadvantages are its potential for damaging adjacent tissue, producing large fragments, and occasionally failing to fragment the hardest calculi, including calcium oxalate.

Ballistic Lithotripsy

Ballistic lithotripsy uses a small endoscopic jackhammer to generate energy that uniquely targets inflexible stones. This technique is efficient, very safe, and especially good for large, hard stones. The main disadvantage of this technique is that it requires a rigid lithotriper and a straight ureteroscope.

Ultrasonic Lithotripsy

Ultrasonic lithotripsy was the first intracorporeal technique. Like the ballistic technique, it requires a rigid endoscope. Ultrasound waves are generated by electrical stimulation of a plate inside the ultrasound probe. This technique is more commonly used percutaneously (through the skin) as opposed to through a ureteroscope.