Lithotripsy

Lithotripsy is a technique that breaks stones inside the body without a surgical incision. We'll focus on extracorporeal shock wave lithotripsy (ESWL), commonly used to treat stones less than 2.5 centimeters but larger than 5 millimeters within the kidney or upper portion of the ureter (a tube that drains urine from the kidney to the bladder).


Indications
Extracorporeal shock wave lithotripsy may be recommended if:
the kidney stone(s) hasn't passed after a reasonable period of time and you're in considerable pain
the stone(s) may be causing repeated urinary tract infections
the kidney tissue is damaged
the stone(s) causes constant bleeding
the stone(s) grows larger

Patient preparation
Prepare for ESWL by eating a light meal (soup, salad, toast, etc.) the night before the procedure. Don't eat or drink anything after midnight, including coffee, tea or water the morning of the treatment. Follow other instructions your doctor provides, and plan to take it easy for a few days after treatment.

Procedure
Anesthesia will help you lie still during the procedure, which lasts about an hour. Often, the doctor will let you decide between several types of anesthesia. For example, you may be able to choose a spinal block, which would allow you to remain alert throughout the procedure.
During the procedure, you'll be positioned in a stainless steel tub filled with warm water or placed on a soft cushion. The doctor will use X-ray equipment or ultrasound to precisely target the stone(s). Then, a machine called a lithotripter will produce high-energy sound waves that break the stone(s) into fragments as small as grains of sand. Most of these fragments should pass easily through your urinary tract with the flow of urine, often within two weeks.


Postprocedure care
After the anesthesia wears off, you'll be encouraged to walk and drink lots of fluids. Your urine will be strained to collect the stone fragments for analysis. The procedure is typically done on an outpatient basis, but some people may need to spend the night in the hospital.
For a few days after treatment you may notice blood in your urine. There may also be some bruising and minor back discomfort from the shock waves. Finally, you may be asked to avoid aspirin and other drugs that would affect blood clotting for several weeks. You'll have a follow-up visit with your doctor about two weeks after the procedure.


Benefits
With ESWL, you can avoid major surgery and possible complications. Recuperation is about 48 hours, compared to weeks for major surgery. A lengthy hospital stay isn't usually necessary. Plus, no incision is required.

Risks
Sometimes treatment must be repeated because it doesn't break up all the stones. There's the possibility a stone fragment may become lodged in a ureter and cause a blockage, making surgical removal of the fragment necessary. Symptoms of a blockage include nausea or vomiting, fever or uncontrolled pain. Be sure to notify your doctor if you experience any of these symptoms after your procedure. Finally, complications are possible with any type of anesthesia.

Considerations
The procedure may not be appropriate if you:
have a pacemaker
have a serious heartbeat problem
have uncorrected bleeding disorders
are pregnant
weigh more than 300 pounds
have abdominal aortic aneurysms (a weakness in an abdominal artery, a blood vessel that carries blood from the heart to the rest of the body)
have other serious medical conditions such as cancer or kidney failure