Extracorporeal Shock Wave Lithotripsy for Kidney Stones
(Lithotripsy for Kidney Stones)
Definition
Extracorporeal shock wave lithotripsy is a nonsurgical treatment for kidney stones. It uses high-energy shock waves to break the stones into tiny pieces. The pieces can then be passed with urine.
Kidney Stones
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Reasons for Procedure
Lithotripsy is used to remove kidney stones that:
- Are too large to pass
- Cause constant pain
- Block the flow of urine
- Cause an ongoing infection
- Damage kidney tissue
- Cause bleeding
Most people who have lithotripsy for kidney stones are free of stones within three months of treatment. Patients with stones in the kidney and upper ureter have the most success with treatment. There may be fragments that are too large to pass after the procedure. They can be treated with lithotripsy again.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Blood in the urine
- Bruising in the back or abdomen
- Pain as the stone fragments pass
- Failure of stone fragments to pass, requiring additional surgery
- Need for additional treatments
- Reaction to anesthesia
Some factors that may increase the risk of complications include:
- Bleeding disorders or taking medications that reduce blood clotting
- Obesity
- Skeletal deformities
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam
- Blood and urine tests
- Imaging studies to help locate the stones
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs, such as ibuprofen and naproxen
- Blood thinners, such as warfarin
- Anti-platelets, such as clopidogrel
Anesthesia
Heavy sedation or general anesthesia is usually used. Heavy sedation will keep you calm. With general anesthesia, you will be asleep. It will help you remain still and avoid discomfort.
Description of the Procedure
Shock waves can be passed to the stones in two ways:
- Water bath immersion—You will be placed in a tub of lukewarm water
- Soft cushion—You will be placed on soft cushions on top of a table
Your doctor will use x-rays or ultrasound to locate the stone. Your body will be positioned to target the stone. Shock waves will be passed through the stones until they are crushed. They will be crushed into pieces as small as grains of sand.
How Long Will It Take?
45-60 minutes
How Much Will It Hurt?
Anesthesia prevents pain during the procedure. There may be some pain and discomfort afterward from the passage of broken stones. There may also be some bruising on the area treated. Pain and discomfort after the procedure can be managed with medication.
Postoperative Care
You will be able to move almost immediately after the procedure. Be sure to follow your doctor's instructions, which may include:
- Drink plenty of water in the weeks after the procedure to help the stone pieces pass.
- You will likely be able to resume daily activities within 1-2 days.
- Take oral pain medication as directed to help manage pain and discomfort.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Extreme urge or inability to urinate
- Excessive blood in your urine
- Signs of infection, including fever and chills
- Nausea and/or vomiting that you cannot control with the medications you were given after the procedure
- Pain that you cannot control with the medications you have been given
- Cough, shortness of breath, or chest pain
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Kidney Foundation
http://www.kidney.org
National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov
CANADIAN RESOURCES:
Canadian Urological Association
http://www.cua.org
The Kidney Foundation of Canada: Northern Alberta and the Territories Branch
http://www.kidney.ab.ca
REFERENCES:
Kidney stones in adults. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.nidd.... Updated January 28, 2013. Accessed May 21, 2013.
Lithotripsy. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/content/lithotripsy.cfm. Accessed May 21, 2013.
Kidney and ureteral stones: Surgical management . American Urological Association website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=32. Updated January 2011. Accessed May 21, 2013.
Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated May 17, 2013. Accessed May 21, 2013.
Last reviewed May 2013 by Michael Woods, MD; Brian Randall, MD
Last Updated: 5/21/2013