Lithotripsy for Kidney and Ureteral Stones: How is it Done?

Lithotripsy is a procedure that uses a laser or shock waves to break down stones in the ureter or kidney.

Development of stones in the ureter, kidney, and gallbladder is common. Doctors believe these stones form due to numerous reasons. The stones can block the flow of urine and cause damage to kidneys. To break down the stones, health experts will prescribe few medications. But if the medicines fail to break the stones, doctors will suggest the patient to undergo lithotripsy. 

There are two types of lithotripsy: (1) Laser Lithotripsy and (2) Extracorporeal Shock Wave Lithotripsy (ESWL). Laser lithotripsy is sometimes referred to as Flexible Ureteroscopy and Laser Lithotripsy (FURSL) as doctors use a tool called Ureteroscope.

According to doctors, both procedures are effective in breaking the stones. The type of lithotripsy is dependent on numerous factors like overall health and the type of stone.

Take a look at each type closely to understand the surgery in detail.

Flexible Ureteroscopy and Laser Lithotripsy (FURSL)

Doctors use an endoscope in this procedure to treat stones formed in the ureter. An endoscope is a flexible tube with a camera and light attached to a monitor that guides the doctor to see inside a body cavity or an organ.

When the doctor finds the stone with the help of an endoscope, he or she uses a laser to break it down. Approximately, this surgery takes about 30 minutes and most patients are allowed to go home on the same day.

Doctors believe the broken fragments will pass through the urine in a few days post-surgery.

Extracorporeal Shock Wave Lithotripsy (ESWL)

Doctors use ESWL to produce shock waves that break the stones. During this procedure, a surgeon uses a machine called a lithotripter that produces sound waves that aim directly to the stones.

These shock waves only affect the stones and do not harm any bone, muscle, or skin. ESWL breaks the stones into small pieces that get eliminated through urine within a few days. 

The procedure takes approximately 1 hour. In most cases, the patients also gets permission to go home on the same day.

Lithotripsy: What is it for?

Often stones are so tiny that the body excretes them through urine without you even noticing. But, in some cases, they are big enough to cause extreme pain and block urine flow. In such cases, lithotripsy is performed to break the stones into smaller pieces so they can pass through urine. Lithotripsy is suitable for patients with small stones that can be easily seen in an X-ray.

Risks of Lithotripsy

Since the procedure is non-invasive, it is generally safe. However there are still some risks like:

• Infection
• Bleeding around kidney
• Pain
• Need for more treatments
• In rare cases, high blood pressure or kidney failure

How to Prepare for a Lithotripsy

Before undergoing lithotripsy, a person should inform the doctor about every drug, supplement, or OTC medicine he or she is using. Doctors may suggest stopping the consumption of a few medicines before undergoing the procedure which can interfere with the process in any manner.

You may be required to take certain blood tests before the surgery. Tell your healthcare provider if you are pregnant or you think you may be. Pregnant patients cannot undergo this procedure as this may harm the unborn child.

A patient should ask a doctor the type of anaesthesia a surgeon will use for this procedure. Commonly, a surgeon uses general anaesthesia that puts a patient in deep sleep during the procedure.

If a doctor suggests general anesthesia, the patient cannot take any food and beverages for at least 6 hours before lithotripsy. However, sometimes, a surgeon may use local anaesthesia that numbs the area throughout the procedure.

What Happens During a Lithotripsy?

The type of procedure depends on the person’s condition and the type of kidney stone. 

Typically, lithotripsy follows below pointers:

• The patient will need to remove his or her jewellery and other objects to prevent any interference during the procedure.
• A surgeon will insert an intravenous (IV) line in the arm or hand.
• A doctor may use local or general anaesthesia to make the body area numb or make a person sleep throughout the procedure. 
• For ESWL, the patient lies on the table with the lithotripter positioned to target the kidney stone location. 
• A surgeon will pass a water-filled cushion between the lithotripter and body to produce the shock waves properly. 
• These shock waves cause no pain. Many surgeons place a stent in the ureter that helps broken stones to pass smoothly.
• For FURSL, a surgeon will insert a ureteroscope into the bladder to reach the ureter and kidney, if required. The doctor will locate the stone and will use the laser to break the stones.

Recovery Period

After the procedure, when the patient wakes up from the anaesthesia, nurses will monitor the patient for at least an hour. If the patient is stable and comfortable, he or she gets the approval to go home. Before leaving the hospital, the doctor will provide essential health instructions that the patient should follow. 

Doctors believe a patient may experience pain in the flank and back but pain relief medicines can help reduce inflammation. Very few people experience mild skin bruising due to shock waves.  

Typically, a person can resume work or daily life within a day or two after ESWL. However, the patient will have a follow-up appointment post-procedure, maybe within a few weeks.

Anyone undergoing a FURSL procedure may take a week to recover. However, both ESWL and FURSL may take a longer time for a full recovery.