• Laser Lithotripsy

    Definition

    Laser lithotripsy is a procedure to break apart kidney stones in the urinary tract. It is done with a ureteroscope passed into the tubes of the urinary tract. Incisions are not needed.
    The laser breaks the kidney stones into smaller pieces that can either be removed by the surgeon or pass out of the body in the urine.
    Kidney Stones
    Kidney Stones
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Kidney stones can become trapped anywhere in the urinary tract, including the kidney and the ureter. The ureter is a tube that carries urine from the kidneys to the bladder. If a stone gets stuck in the ureter it can cause a blockage and back up of urine into the kidney. They can also be quite painful.
    Laser lithotripsy is used to break apart the kidney stone so that it can pass through the ureter. The pieces will either be removed by the surgeon using a special basket or left in place where they will move from the ureter to the bladder, then out of the body with the urine.
    Laser lithotripsy may be chosen if other non-surgical treatments have failed or if kidney stones are:
    • Too large to pass
    • Irregular in shape
    • Causing bleeding or damage to surrounding tissue

    Possible Complications

    Complications are rare, but all procedures have some potential risk. Your doctor will review potential problems, like:
    • Increasing or large amounts of blood in the urine
    • Injury to the urinary tract
    • A temporary stent (placed to keep the ureter open) may move out of position
    • Infection
    • Need for additional procedures to remove stone fragments that do not pass
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Blood and urine tests
    • Imaging tests to help locate the stones
    • Chest X-ray
    • Electrocardiogram (EKG) to evaluate electrical activity of the heart
    • Analysis to determine size and type of the stones
    You may need to:
    • Arrange for a ride home after the procedure.
    • Arrange for help at home during recovery.
    • Stop certain medications up to a week before the procedure.
    • Avoid eating or drinking after midnight prior to the procedure.
    Talk to your doctor about any allergies you may have, or what medications or supplements you currently take and may need to stop.

    Anesthesia

    General anesthesia will be used. You will be asleep through the procedure.

    Description of Procedure

    A ureteroscope is an instrument with a long thin tube that looks like a straw. The doctor can use this scope to view the urinary tract, find kidney stones, and pass instruments to the stone.
    The scope enters the urinary tract through the urethra, the tube that carries urine out of the body. The scope continues to pass through the urethra, to the bladder, into the ureter and then to the stone.
    Once the doctor sees the stone, a fiber will be sent through the scope to the stone. The fiber can create a laser beam to break up the stone. Small pieces may be removed using a basket that is passed through the scope. Small grain-like pieces may remain and will be gradually passed through the urine.
    A temporary stent may be placed in the ureter. The stent will keep the ureter open, improve urine flow, and help the stone pieces pass. The stent will be removed after a few weeks.

    How Long Will It Take?

    Up to 1 hour

    How Much Will It Hurt?

    Anesthesia will prevent pain during surgery. The ureter bladder can spasm and cause pain after the surgery. There may also be some pain or discomfort in the back. Stents can also cause discomfort in some. Pain and discomfort after the procedure can be managed with medications.

    Post-procedure Care

    At the Care Center
    The medical team will monitor your recovery including your blood pressure, pulse, and breathing. Recovery may also include:
    • Pain medications
    • Antibiotics to decrease the risk of the infection
    • X-rays to look for remaining stone fragments or confirm the stent placement
    Healthcare providers will take steps to reduce your chance of infection, such as:
    • Washing their hands
    • Wearing gloves or masks
    There are also steps you can take to reduce your chances of infection, such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    At Home
    Full recovery can take 1-2 weeks. Fatigue and discomfort is common but will fade during recovery. It may require minor changes to your daily routine.

    Call Your Doctor

    It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
    • Inability to urinate
    • Pain that cannot be controlled with the medications you’ve been given
    • Redness, warmth, excessive bleeding, or drainage
    • Signs of infection, including fever or chills
    • Persistent nausea or vomiting
    • Increasing or large amounts of blood in the urine
    • New or worsening symptoms
    If you think you have an emergency, call for emergency medical services right away.

    RESOURCES

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

    Urology Care Foundation http://www.urologyhealth.org

    CANADIAN RESOURCES

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

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

    References

    Kidney stones in adults. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/kidney-stones-in-adults/Pages/facts.aspx. Updated February 2013. Accessed March 7, 2016.

    Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 24, 2016. Accessed March 7, 2016.

    Surgery for kidney stones. Washington University School of Medicine in St. Louis website. Available at: http://www.urology.wustl.edu/en/Patient-Care/Kidney-Stones/Surgery-for-Kidney-Stones. Accessed March 7, 2016.

    Ureteroscopy. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones%5FUreteroscopy. Accessed March 7, 2016.

    Ureteroscopy and laser lithotripsy. University of Florida Department of Urology website. Available at: http://urology.ufl.edu/patient-care/stone-disease/procedures/ureteroscopy-and-laser-lithotripsy. Accessed March 7, 2016.

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