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What is lithotripsy?

Lithotripsy is a 30 - 90-minute non-invasive kidney stone treatment procedure that breaks the stones in the body into small fragments. Lithotripsy can be performed to break stones in the various organs of the body such as kidney, gallbladder, liver, etc.

There are several types of lithotripsy procedures for kidney stones removal:

• Extracorporeal shock wave lithotripsy (ESWL)
• Shockwave lithotripsy (SWL)
• Laser lithotripsy
• Percutaneous lithotripsy
• Endoscopic lithotripsy

A local, regional, or general anesthesia is used, depending on the patient’s assessment and the technique to be used. Anesthesia helps the patient to remain still and reduce any discomfort. Lithotripsy can also be delivered with light sedation. The procedure may require several sessions to completely break the stones. Each session may cost between Rs. 15,000 to 80,000 depending on the type, size and location of the kidney stones. 

How is the lithotripsy procedure performed? 

Extracorporeal shock wave lithotripsy (ESWL): Shock waves are used to break the kidney stones into smaller pieces that can now easily pass through the urinary tract. This procedure is generally used to remove stones which are 4 mm to 20 mm in diameter.

Shockwave lithotripsy (SWL): High-energy shock waves are targeted directly at the kidney stones, causing each stone to fragment and become small enough to pass through the urinary tract. The results of SWL are generally satisfactory if the size of the stone is less than 20 mm in diameter.

Laser lithotripsy: In this procedure, a laser is directly targeted onto the kidney stones to break them into smaller pieces, which then pass through the urinary tract. Laser lithotripsy works best with stones less than 20 mm in diameter.

Percutaneous lithotripsy: This is a minimally invasive procedure, in which a tiny incision of approximately 1 cm is made through the skin. A hollow tube with a probe is inserted through the incision into the kidney. The stone is then broken into fragments and removed through the tube. This procedure is generally used to remove stones larger than 20 mm in diameter.

Endoscopic lithotripsy: In this procedure, an endoscope or cystoscope is used to reach the stone, through the urinary tract. Laser waves are then directed onto the stone to break it into small fragments.

In general, any type of lithotripsy procedure (except percutaneous nephrolithotripsy) follows this process:

1. At the outset, an anesthetist administers an anesthetic agent to ensure that you remain relaxed and pain-free during the procedure.
2. Once the anesthesia begins to take effect, then you will be positioned you on a water-filled cushion or in a water-filled tub.
3. Thereafter, the urologist identifies the areas through which the stones can be accessed directly. (The stones are located through X-Ray and ultrasound prior to beginning the lithotripsy procedure.)
4. He then directs a sequence of shock waves to shatter and fragment the kidney stone(s). During this process, you may experience a slight buzzing feeling on your skin.
   Please Note: The stone(s) are monitored continuously through fluoroscopy, or ultrasound, during the procedure.
5. Once the stone fragments are small enough to pass through the urinary system, the procedure ends.

Please Note: Depending on the condition of your physical health, a stent may be placed in the ureter to help the stone fragments pass out easily from your body.

Am I eligible for lithotripsy? 

You are eligible for lithotripsy if:

1. You have small kidney stones (generally smaller than 2 cm) easily seen on an X-Ray
2.  you have stones in the upper portion of the ureter

You are ineligible for lithotripsy if you: 

1. Are pregnant
2. Have active urinary tract infection
3. Display symptoms of obstruction of the kidney
4. Take blood-thinning medications that cannot be discontinued
5. Have a stone composition that includes cystine and certain types of calcium phosphate stones, as these stone types may not fragment well during the lithotripsy procedure.

Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depend on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure. 

What risks will I face while undergoing the lithotripsy procedure?

Some of the potential risks of undergoing the lithotripsy procedure include: 

• injury to surrounding skin, tissue, nerves, muscles and organs
• ineffective/incomplete stone fragmentation
• accumulation of a large number of unpassable stone fragments within the ureter

How will I benefit after undergoing a lithotripsy procedure?

Compared to open surgery, undergoing lithotripsy can have more benefits:

• this is a non-invasive treatment.
• the procedure is not time-consuming and lasts only 30 to 90 minutes.  For certain patients, depending on their health conditions, an overnight stay in the hospital may be suggested.
• the recovery time from a lithotripsy procedure is normally 1-3 days, as opposed to an open surgery from which a patient can take upto 6 weeks to recover.

What are my alternatives to lithotripsy?

The alternatives to lithotripsy include:

• Prescribed medicines by the doctor which can dissolve small stones.
• Ureteroscopy
• Percutaneous Nephrolithotomy
• Open Surgery

What are the pre-operative guidelines I should follow for lithotripsy? 

The usual pre-operative guidelines which are followed prior to a lithotripsy procedure are:

A complete physical examination by your doctor to ensure you are in good health before undergoing the procedure.  The doctor will also ask for your medical history prior to the procedure. You may have to undergo blood tests or other diagnostic tests. The tests performed may include:

• blood tests
• an electrocardiogram (ECG)
• a comprehensive set of metabolic tests
• a urine test
• tests that measure the speed of blood clotting

1. Tests are done to determine the number, location, and size of the stone(s). These may include X-ray Ultrasound, Intravenous pyelogram (IVP).
2. Sign a consent form expressing your consent for the procedure by taking responsibility for the risks related to it. You will be made aware of any risks related to the procedure by your doctor.
3. Depending on the type of anesthetic to be used, your doctor may instruct you to fast before the procedure.
4. You need to inform your doctor if you have a known sensitivity or allergy to any medications, latex, tape, or anesthetic agents (local and general).
5. Your surgeon may ask you to take a laxative the day before surgery to minimize the risk of constipation during the first few days of recovery.
6. You need to inform the doctor if you are pregnant or suffer from any heart disease.
7. Inform the doctor all the medications you take (prescription and over-the-counter). Especially if you take any anticoagulant (blood-thinning) medications, aspirin, or any other medication that affects blood clotting. Your doctor may ask you to stop taking the medicines a week or so prior to the procedure.
8. Notify your doctor if you have a history of bleeding disorders.
9. Based on your medical condition, your doctor may request other specific preparations.
10. Before the Lithotripsy procedure, a radio-opaque dye is injected into a vein in the arm. Make sure the doctor rules out any possible allergies you may develop from the dye. The dye shows up on the x-ray as it travels through the bloodstream and is excreted by the kidneys. The dye then flows down the ureter and into the urinary bladder. The radio-opaque dye highlights the kidney stones on the x-ray.
11. If you smoke or drink alcohol, you will be advised by the doctor to stop smoking and drinking alcohol at least a week or two prior to the procedure.
12. Some patients may be advised by the doctor to have a stent placed prior to the lithotripsy procedure. It is a plastic tube placed in the ureter which allows the free passage of the broken stones and urine after the procedure.
13. Follow the instructions of your doctor.

What are the complications of lithotripsy? 

Complications of lithotripsy may include, but are not limited to, the following:

• infection
• bleeding around the kidney
• stone fragments left behind making it necessary to undergo more lithotripsy procedures
• obstruction of the urinary tract by stone fragments
• blood in urine
• fever
• Local pain

What are the post-operative guidelines I need to follow after undergoing a lithotripsy procedure?

Following are the post-operative guidelines after getting lithotripsy done:

• You may observe blood in the urine after the lithotripsy procedure. This is a temporary condition that clears up after a few days.
• The doctor may instruct you to collect your urine for about 24 hours after the procedure and send it to the laboratory for analysis of the stone debris.
• You will be advised to drink extra fluids to maintain good kidney health. It will help to dilute your urine and reduce any discomfort when the stone fragments pass. Drinking plenty of water will also reduce the chances of recurrence of kidney stones. So, make water your most frequent drink.
• Promptly take all the medications prescribed by the doctor.
• Regularly follow up with your urologist as recommended to ensure an uneventful recovery.
• If a stent is inserted during lithotripsy, it is normally removed when you begin to recuperate. After 7 to 10 days of undergoing the procedure, you can resume your normal activities.
• You will be advised by the doctor to refrain from smoking and drinking alcohol for several weeks. Smoking and drinking alcohol can impede the healing process.

What is the recovery period after undergoing a lithotripsy procedure? 

Most patients usually resume work after 2 days of the procedure. Complete recovery can take up to 2 weeks.  

Are the results of lithotripsy permanent? 

In some cases, kidney stones that are too large to pass spontaneously may remain in the urinary tract. Such cases require repeat lithotripsy procedures. Another strong probability is the formation of new kidney stones if proper preventive care is not taken after the kidney stone removal procedure. Such a case will again require a lithotripsy procedure.

How do I know if the lithotripsy procedure I underwent is a success? 

Several weeks after the lithotripsy procedure your urologist will request a post-procedure follow-up x-ray which will reveal whether the stone fragments have passed out of your urinary tract. If there are no signs of stones, then the procedure is determined as a success. In some cases, however, a few stone fragments may remain in the urinary tract which are too large to pass spontaneously. In such cases, a repeat lithotripsy procedure or an alternative procedure may be required at the discretion of the treating urologist.