Sarah Lewis, PharmD
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 and ultrasound therapeutics.
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:
You will dress in a patient gown and lie on a water-filled cushion on top of a procedure table.
Your team will insert an intravenous (IV) line into your arm or hand.
If your stone puts you at risk of infection, your team will administer antibiotics before your procedure begins.
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.
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.
Your team will locate the stone using either ultrasound or fluoroscopy (real-time moving X-rays).
Your team will position the lithotripter to target the stone and will activate the ultrasound shock waves.
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.
You should expect to receive sufficient pain and sedative medications so that you stay comfortable. Tell your care team if you are uncomfortable.
What are the risks and potential complications of lithotripsy?
Complications after lithotripsy are uncommon, but any medical procedure involves risk and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery.
Risks and potential complications of lithotripsy include:
Adverse reaction or problems related to sedation, anesthesia or medications such as an allergic reaction and problems with breathing
Bleeding around the kidney
Bloody urine for a few days (common)
Discomfort when stone fragments pass through the urinary tract. Your doctor may insert a stent to help reduce this complication.
Repeat need for lithotripsy due to large stone fragments
Small risk of cancer due to radiation exposure. Your care team follows strict standards for X-ray techniques and will use the lowest amount of radiation possible to make the best images. Your doctor will generally not order an X-ray if you are pregnant due to the danger of radiation to an unborn child.
Soreness, discomfort and bruising in the abdomen or back (common)
Urinary tract obstruction from stone fragments
Reducing your risk of complications
You can reduce the risk of certain complications by:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery. This usually includes not eating or drinking for several hours before your lithotripsy.
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns such as fever, chills, or increase in pain
Taking your medications and returning for follow-up care exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my lithotripsy?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for a lithotripsy by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Having a lithotripsy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need lithotripsy? Are there any other options for treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my lithotripsy?
Knowing what to expect after a lithotripsy can help you get back to your everyday life as soon as possible.
How will I feel after the lithotripsy?
You may have soreness and discomfort in your abdomen or back after lithotripsy. To reduce discomfort, take slow deep breaths. You will likely have pain medication to control your pain. You might feel a little drowsy from the sedative and pain medications you were given. Tell your doctor if your pain is not well controlled by your medication because it can be a sign of a complication.
When can I go home?
You will stay in the recovery room or radiology department for a short period of time after your lithotripsy. You will be discharged home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes a couple of hours, depending on the type of sedation you receive.
You may still be a bit drowsy and will need a ride home from your procedure. You will not be able to drive for about 24 hours, and someone should stay with you during that time. Most people can resume normal activities within a day or two.
It is important to drink plenty of water to help pass the stone fragments after lithotripsy. You may feel pain and nausea when you pass a stone fragment. Your doctor may give you pain medication, antibiotics, and anti-inflammatory medications to make you more comfortable. Certain medications can increase the risk of bleeding, so only take those recommended by your doctor.
You may continue to pass stone fragments for up to eight weeks after your lithotripsy. Your doctor may ask you to strain your urine in order to recover the stone fragments, which are sent to a laboratory for analysis. This may help guide preventive strategies in the future.
When should I call my doctor?
After a lithotripsy you should keep your follow-up appointments and call your doctor if you have concerns between appointments. Call your doctor if you have:
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