Lithotripsy Procedure: What is It and When is It Performed?

Lithotripsy is a procedure that helps to fragment kidney stones to expel them with urine. In this article, we'll explain how it's done and what it's used for.

Written and verified by the doctor Leonardo Biolatto.

Last update: 02 May, 2023

Doctors use the lithotripsy procedure very frequently. It’s one of the therapeutic options for kidney stones (also called lithos). These are hard deposits of minerals and salts that form inside the kidneys.

The problem is that when these stones move through the urinary tract and distend it, they cause a lot of pain. They’re also associated with obstruction of the urinary tract. Lithotripsy is intended to fragment these stones.

The idea is that the patient can expel them more easily. There are different ways of performing the technique and certain important aspects to take into account before using it. Therefore, in this article, we’ll explain everything you should know about this procedure.

How does the lithotripsy procedure work?

Lithotripsy, as we pointed out in the introduction, is a medical procedure used to treat kidney stones. As an article from the Serrate & Ribal Urology Institute explains, the word comes from Greek and Latin. Lithos means ‘stone’ and terere means ‘to crush’.

Kidney stones are a condition with high prevalence in the general population. For this reason, the lithotripsy procedure has become a very useful and widely used technique. It consists of fragmenting the stones in the kidney or along the urinary tract to make it easier to expel them with urine.

For this purpose, shock waves or a laser are used extracorporeally and non-invasively. The device used is called a lithotripter in the case of shock waves. The procedure is painless and doesn’t require manipulation of the patient.

So much so that it’s usually performed on an outpatient basis and without anesthesia. Other complementary tests, such as ultrasound and X-ray, are used to locate the exact position of the stones.

The types of lithotripsy

There are different modalities of lithotripsy. The two main types are extracorporeal shock wave lithotripsy (ESWL) and laser lithotripsy (FURSL).

Both techniques help to fragment stones within the renal pathway. However, it’s important to be familiar with them to know which one is more indicated depending on the patient’s health conditions. The number and type of stones present also have an influence.

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy, as the name implies, uses shock waves to break up the stones. The machine is a lithotripter. It’s responsible for directing waves to the point where the stones are located.

What is beneficial is that these waves only affect the stones. In other words, they don’t damage the skin, muscles, or any other tissue. The procedure takes approximately one hour to perform.

Laser lithotripsy

Laser lithotripsy involves inserting a small flexible tube, called an endoscope, through the urinary tract. The endoscope has a camera on the end that lets the doctors see the inside of the ducts.

When they locate the stone, they use a laser directly on the stone to break it into fragments. This technique is shorter than extracorporeal shock wave lithotripsy, lasting half an hour.

However, the fact of having to introduce the instruments may generate more discomfort or discomfort in the patient. As in the previous procedure, the patient can go home on the same day of the procedure.

How effective is lithotripsy?

Lithotripsy is a widely used technique because it’s considered safe and effective. According to a study published in the Oman Medical Journal, the success rate is around 88% of cases in the ureter. In kidney stones, the percentage is somewhat lower, but also very high (74 %).

In addition, very few have complications, such as urinary tract infections. Another article from the National Kidney Foundation states that 70-90% of people who undergo lithotripsy are stone-free in the months that follow.

However, it’s possible that on some occasions the fragments may still be too large to pass. Under these circumstances, the doctor may have to repeat the procedure if necessary.

Preparation for the procedure

Before doctors perform a lithotripsy, they need to know the patient’s history, treatments, and background. In addition, they usually perform a series of complementary tests. The idea is to try to locate the stones and know their dimensions before fragmenting them.

For this purpose, doctors can perform an intravenous pyelogram. This is a test similar to an X-ray that uses a dye to locate the stones. They may also prescribe ultrasound scans.

In the days before lithotripsy, the patient may have to stop taking certain drugs. In particular, anticoagulant drugs, as they increase the risk of bleeding when expelling the stones.

General anesthesia isn’t always necessary. In fact, there are many occasions when doctors perform this procedure under local or regional anesthesia on an outpatient basis. However, some patients remain hospitalized to monitor the possibility of complications.

What’s the lithotripsy procedure like?

The two types of lithotripsy are similar but have important differences. In both of them, the patient is usually lying down, with or without anesthesia. The procedure itself isn’t painful, but the expulsion of the fragments is.

Some of the fragments may cause a blockage in the urinary tract. In these cases, it’s necessary to perform an endoscopy through the ureter to remove it. In addition, it’s worth mentioning that, although less frequent, bleeding, fever, or even infection may occur.

The big difference to keep in mind is that in laser lithotripsy it’ll be necessary to introduce an endoscope through the patient’s urinary tract. This can be more uncomfortable and unpleasant.

Recovery after the lithotripsy procedure

After the procedure, the patient usually has to rest in the hospital for at least one hour. This time may be extended if anesthesia has been used. It’s necessary to check that the person is stable and that there aren’t any complications.

In the following days, if the doctors have used extracorporeal shock wave lithotripsy, the patient can return to work. When performed by laser, recovery is slower. This is because the procedure with the endoscope is invasive.

As mentioned above, pain or blood in the urine is likely to occur after the procedure. Hematomas are also frequent in the skin, in the area where the shock waves have had an impact. It’s therefore recommended to rest, take painkillers and consult in the event of any problem or warning sign.

Lifestyle and prevention

The truth is that kidney stones can be caused by multiple factors. Certain factors influence their occurrence. The incidence is very high.

One of the habits that can help to reduce their appearance is to drink more liquids. Likewise, people who frequently suffer from them should try to change their dietary characteristics.

For example, doctors recommended we eat less animal protein and limit sodium. In any case, it’s up to the physician to make a recommendation based on each patient and the causes of the stones.