Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Extracorporeal Shock Wave Lithotripsy for Kidney Stones

(Lithotripsy for Kidney Stones)
by Krisha McCoy, MS
Definition

Extracorporeal shock wave lithotripsy is a nonsurgical treatment for stones in the kidney and ureter. It uses high energy shock waves to break kidney stones into tiny pieces. The pieces can then be passed with urine.

Reasons for Procedure

Lithotripsy is used to remove kidney stones that:

  • Are too large to pass
  • Block the flow of urine
  • Cause an ongoing infection
  • Cause bleeding
  • Cause constant pain
  • Damage kidney tissue

Most people who have lithotripsy for kidney stones are free of stones within three months of treatment. Patients with stones in the kidney and upper ureter have the most success with treatment. There may be fragments that are too large to pass after the procedure. They can be treated with lithotripsy again.

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 which may include:

  • Blood in the urine
  • Bruising in the back or abdomen
  • Failure of stone fragments to pass, requiring additional surgery
  • Infection
  • Need for additional treatments
  • Pain as the stone fragments pass
  • Reaction to anesthesia

Some factors that may increase the risk of complications include:

  • Presence of a dilated aorta ( aneurysm )
  • Bleeding disorders or taking medicines that reduce blood clotting
  • Obesity
  • Presence of a pacemaker
  • Skeletal deformities
What to Expect
Prior to Procedure

Your doctor may do the following:

  • Blood and urine tests
  • IVP (intravenous pyelogram) —an x-ray of the urinary system taken after the injection of contrast material
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
  • Physical exam
  • Spiral CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
  • X-ray of the abdomen

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Aspirin or other anti-inflammatory drugs
Anesthesia

Heavy sedation or general anesthesia is usually used. Heavy sedation will keep you calm. With general anesthesia, you will be asleep. It will help you remain still and avoid discomfort.

Description of the Procedure

You will be placed on a table attached to the lithotripsy equipment. You will lie on top of a soft cushion or membrane through which the waves pass. Your doctor will use x-rays or ultrasound to locate the stone. Your body will be positioned to target the stone. One to three thousand shock waves will be passed through the stones until they are crushed. They will be crushed into pieces as small as grains of sand.

How Long Will It Take?

45-60 minutes

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. There may be some pain and discomfort afterward from the passage of broken stones. There may also be some bruising on the area treated. Pain and discomfort after the procedure can be managed with medicine.

Postoperative Care

You will be able to move almost immediately after the procedure. Be sure to follow your doctor's instructions , which may include:

  • Drink plenty of water in the weeks after the procedure to help the stone pieces pass.
  • Take oral pain medicine as directed to help manage pain and discomfort.
  • You will likely be able to resume daily activities within 1-2 days.
Call Your Doctor

After arriving home, contact your doctor if any of the following occurs: In case of an emergency, call for medical help right away.

  • Cough, shortness of breath, or chest pain
  • Excessive blood in your urine
  • Extreme urge or inability to urinate
  • Nausea and/or vomiting that you cannot control with the medicines you were given after the procedure
  • Pain between your ribs and back as the stones pass
  • Pain that you cannot control with the medicines you have been given
  • Signs of infection, including fever and chills

Last reviewed: December 2010 by Adrienne Carmack, MD.

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