• Extracorporeal Shock Wave Lithotripsy for Kidney Stones

    (Lithotripsy for Kidney Stones)

    Definition

    Extracorporeal shock wave lithotripsy is a nonsurgical treatment for stones in the kidney and ureter. It uses high-energy shock waves to break kidney stones into tiny pieces. The pieces can then be passed with urine.
    Kidney Stones
    Kidney Stones
    Copyright © Nucleus Medical Media, Inc.

    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

    Complications are rare, but no procedure is completely free of risk. If you are planning to have this procedure, your doctor will review a list of possible complications, which may include:
    • Blood in the urine
    • Bruising in the back or abdomen
    • Infection
    • 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 medicines that reduce blood clotting
    • Obesity
    • Skeletal deformities
    • Presence of a pacemaker
    • Presence of a dilated aorta (aneurysm)

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • X-ray of the abdomen
    • Blood and urine tests
    • Intravenous pyelogram (IVP)—an x-ray of the urinary system taken after the injection of contrast material
    • Spiral CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
    • MRI scan—a test that uses magnetic waves to make pictures of structures inside the body
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

    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

    You will be placed on a table attached to the lithotripsy equipment. You will lie on top of a soft cushion or membrane through which the waves pass. Your doctor will use x-rays or ultrasound to locate the stone. Your body will be positioned to target the stone. One to three thousand 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 medicine.

    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 medicine 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 medicines you were given after the procedure
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    • Pain between your ribs and back as the stones pass
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Urologic Association Foundation http://www.urologyhealth.org

    National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

    National Kidney Foundation http://www.kidney.org

    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.niddk.nih.gov/kudiseases/pubs/stonesadult. Accessed June 24, 2008.

    Lithotripsy. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/content/lithotripsy.cfm. Accessed June 24, 2008.

    Surgical management of stones. American Urological Association website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=32. Accessed November 10, 2009.

    Wein. Campbell-Walsh Urology. 9th ed. Maryland, MO: Saunders; 2007.

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