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  • Electrohydraulic Lithotripsy

    (EHL; Lithotripsy, Electrohydraulic; Intracorporeal Lithotripsy; Lithotripsy, Intracorporeal; Ureteroscopic Stone Removal; Stone Removal, Ureteroscopic)

    Definition

    Electrohydraulic lithotripsy is one of many methods to treat kidney stones or bile stones. It uses an electrohydraulic device with a flexible probe to deliver electricity that breaks apart the stones.
    Kidney Stone
    IMAGE
    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 surrounding tissue
    • Cause bleeding
    This procedure can also be used to remove stones in the bile duct or the pancreatic duct.
    Gallstones
    Gallstones
    Copyright © Nucleus Medical Media, Inc.

    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. Complications may include:
    • Damage or irritation to tissue or surrounding structures
    • Blood in the urine
    • Infection
    • Pain as the stone fragments pass
    • Failure of stone fragments to pass, requiring additional surgery
    • Need for more treatments
    • Reaction to anesthesia
    Factors that may increase the risk of complications include:
    • Bleeding disorders or taking medicines that reduce blood clotting
    • Smoking

    What to Expect

    Prior to Procedure

    Before the procedure, your doctor may do the following:
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure. These medicines may include:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners (eg, warfarin , clopidogrel )

    Anesthesia

    General anesthesia will be used. You will be asleep during the procedure. You will not feel any pain.

    Description of the Procedure

    Your doctor will place a tiny flexible probe through your urethra and up the ureter toward the stone. The probe has two electrodes at the end. Images will help the doctor locate the stone. After the stone is located, the doctor will use the device. An electrical spark will break the stone. A special basket or forceps may be used to grab the stone fragments and remove them. The stone fragments may be allowed to pass in the urine.
    Depending on the size of the stone, more than one probe may be used. A stent may be placed in the ureter. It will help protect the lining while the stone fragments pass or damage is being repaired.
    There may be fragments that are too large to pass after the procedure. These can be treated again with lithotripsy.

    How Long Will It Take?

    30-60 minutes depending on the size and location of the stone

    How Much Will It Hurt?

    Anesthesia prevents pain during the procedure. There may be some pain and discomfort afterward as the broken stones pass. This can be managed with medicine.

    Average Hospital Stay

    This procedure is usually done in an outpatient setting. In most cases, there will be no hospital stay.

    Post-procedure Care

    At the Hospital
    • You will be monitored as you recover from anesthesia.
    • Pain medicine will be given.
    • You may be asked to get up and walk around before leaving the hospital.
    At Home
    Follow your doctor's instructions, which may include:
    • Drinking plenty of water in the weeks after the procedure. This will help the stone pieces to pass.
    • Resuming daily activities within one to two days.
    • You may experience some pain. Take pain medicine as directed to manage any discomfort.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Inability to urinate
    • A lot of 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
    • Pain that you cannot control with the medicines you were given
    • Cough, shortness of breath, or chest pain
    In case of an emergency, call for medical help right away.

    RESOURCES

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

    National Institute of Diabetes and Digestive and Kidney Diseases http://www2.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Urological Association http://www.cua.org/

    Kidney Foundation of Canada http://www.kidney.ca/

    References

    Extracorporeal shock wave lithotripsy for kidney stones. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 30, 2011. Accessed October 19, 2012.

    Gallstones. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated March 20, 2012. Accessed October 19, 2012.

    Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated September 17, 2012. Accessed October 19, 2012.

    Lingeman J, Matlaga B, Evan A. Surgical management of upper urinary tract calculi/electrohydraulic lithotripsy. In: Wein AJ, ed. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 44.

    National Institute of Diabetes and Digestive and Kidney Diseases. Kidney stones in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/stonesadults/ . Updated June 29, 2012. Accessed October 19, 2012.

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