What is lithotripsy?

Lithotripsy is a noninvasive procedure that treats kidney stones that are too large to pass through the urinary tract. Lithotripsy uses ultrasound shock waves to break kidney stones into smaller pieces that can be eliminated in the urine. Lithotripsy is also used to treat stones of the digestive system, such as gallstones and pancreatic stones.

The most common form of lithotripsy is extracorporeal (outside the body) shock wave lithotripsy (ESWL). A machine called a lithotripter generates the ultrasound shock waves that travel through your body until they reach the dense kidney stone. The stone shatters when the ultrasound waves hit it. 

Lithotripsy is the most common procedure for treating kidney stones. Other methods include endoscopic procedures and surgery. Discuss all of your treatment options with your doctor to understand which options are right for you.  

Types of lithotripsy

There are two types of ESWL methods:

  • Table ESWL involves lying on a water-filled cushion on top of a procedure table. The ultrasound shock waves travel through the cushion and into your body. This is the most common form of ESWL.
  • Water bath ESWL involves sitting in a water bath. The ultrasound shock waves travel through the water and into your body. 

Why is lithotripsy performed?

Your doctor may recommend lithotripsy or extracorporeal (outside the body) shock wave lithotripsy (ESWL) to treat:

  • Digestive system stones including gallstones, pancreatic stones, and bile duct stones. Stones need to meet certain criteria in order for ESWL to be an appropriate treatment.
  • Orthopedic conditions including chronic plantar fasciitis, heel spurs, and tennis elbow. Researchers have found that patients with these conditions have improved symptoms, including pain, after ESWL. This treatment is only available at certain treatment centers.
  • Urinary tract stones including kidney, ureter (tube connecting your kidney to your bladder), and bladder stones. Stones need to meet certain criteria in order for ESWL to be an appropriate treatment.

Who performs lithotripsy?

The following specialists perform lithotripsy or extracorporeal (outside the body) shock wave lithotripsy (ESWL):

  • Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.
  • Pediatric urologists specialize in diseases and conditions of the urinary tract and male reproductive organs of infants, children and adolescents. 
  • Interventional radiologists and vascular radiologists specialize in diagnosing and treating diseases using radiological imaging.

How is lithotripsy performed?

Your lithotripsy or extracorporeal (outside the body) shock wave lithotripsy (ESWL) will be performed in an outpatient radiology facility or hospital radiology department. The most common form of ESWL is a table procedure. It takes about one hour and generally includes these steps:

  1. You will dress in a patient gown and lie on a water-filled cushion on top of a procedure table.
  2. Your team will insert an intravenous (IV) line into your arm or hand.
  3. If your stone puts you at risk of infection, your team will administer antibiotics before your procedure begins.
  4. The ultrasound shock waves cause discomfort. You will likely receive general anesthesia, which will put you is a deep sleep and make you unaware of the procedure. As an alternative, you may receive heavy sedation to make you drowsy and relaxed, and possibly a pain medication. 
  5. General anesthesia tends to yield better outcomes than relying on sedation alone. Talk to your doctor about which option is best for you because not all patients are good candidates for general anesthesia.
  6. Your team will locate the stone using either ultrasound or fluoroscopy (real-time moving X-rays).
  7. Your team will position the lithotripter to target the stone and will activate the ultrasound shock waves.
  8. Your team may place a stent in your ureter (tube connecting your kidney to your bladder) to ease the passing of the stone fragments.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel a brief pinch or prick when a team member places your IV. If you receive general anesthesia, you will not remember the procedure. If you receive sedation, you may feel the sensation of tapping on your body during the procedure.&