Lithotripsy: Meaning, Procedure, and Cost

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What is lithotripsy?

Lithotripsy is a 30 - 90-minute non-invasive kidney stone treatment procedure which 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. 

To know more about what causes kidney stones and kidney stone symptoms please see: Kidney Stones: Symptoms, Complications, and Removal

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 lithotripsyThis 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:

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

You are ineligible for lithotripsy if you: 

  • are pregnant
  • have active urinary tract infection
  • display symptoms of obstruction of the kidney
  • take blood-thinning medications that cannot be discontinued
  • have a stone composition which 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 depends 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
  • steinstrasse or an accumulation of a large number of unpassable stone fragments within the ureter

How will I benefit after undergoing a lithotripsy procedure?

Compared to an 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:

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
  • Tests are done to determine the number, location, and size of the stone(s). These may include:
    • X-ray
    • Ultrasound
    • Intravenous pyelogram (IVP)
  • 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.
  • Depending on the type of anesthetic to be used, your doctor may instruct you to fast before the procedure.
  • 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).
  • 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.
  • You need to inform the doctor if you are pregnant or suffer from any heart disease.
  • 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.
  • Notify your doctor if you have a history of bleeding disorders.
  • Based on your medical condition, your doctor may request other specific preparations.
  • 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 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.
  • 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.
  • 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.
  • 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 a lithotripsy done:

  • You may observe blood in the urine after the lithotripsy procedure. This is a temporary condition which 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 upto 2 weeks.  

Are the results of lithotripsy permanent? 

In some cases, the kidney stones which 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.  

 More Topics on Kidney Stone Removal 

People interested in this topic also read: 

 References 

1. Younesi Rostami M, Taghipour-Gorgikolai M, Sharifian R. Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329132/. Accessed March 5, 2018.

2. Pareek G, Hedican S, Lee F, Nakada S. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. 2018. Available at: http://www.goldjournal.net/article/S0090-4295(05)00656-4/abstract. Accessed March 5, 2018.

3. Budia A, Caballer V. Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis. 2018. Available at: https://www.omicsonline.org/peer-reviewed/comparison-of-extracorporeal-shock-wave-lithotripsy-versusureteroscopy-holmium-laser-lithotripsy-in-the-management-of-ureteralston-77614.html. Accessed March 5, 2018.

4. Joost A.P. Leijte, Jorg R. Oddens, and Tycho M.T.W. Lock. Journal of Endourology. February 2008, Holmium Laser Lithotripsy for Ureteral Calculi: Predictive Factors for Complications and Success | Abstract. Onlineliebertpubcom. 2018. Available at: http://online.liebertpub.com/doi/abs/10.1089/end.2007.0299. Accessed March 5, 2018.

5.  Amir Reza Abedi,  Farzad Allameh,  Mohammad Reza Razzaghi,  Behrouz Fadavi,  Hamidreza Qashqai,  Saman Najafi, Arash Ranjbar, Manouchehr Bashirian. The Efficacy and Safety of Laser Lithotripsy in Pregnancy. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474387/. Accessed March 5, 2018.    

6.   Cotton P, Kozarek R, Schapiro R et al. Endoscopic laser lithotripsy of large bile duct stones. Gastroenterology. 1990. Available at: http://www.gastrojournal.org/article/0016-5085(90)90634-D/fulltext. Accessed March 5, 2018.

Would you like to consult a doctor for Lithotripsy ?

Patient Experiences

Rahul
Effective Lithotripsy Treatment
I am very thankful to Dr shyam varma for taking a special care and giving me a pain free surgery. He has in fact shown me all surgery clips after surgery explaining details. He is definitively one of the best urologist for stone treatment. ...Read Less
Doctor in this story :Dr. Shyam Varma
Pace Hospitals - Best Gastro, Liver & Kidney centre 24x7
Shasanka sekhar pattanaik
Undergone Lithotripsy Successfully
Doctor is friendly . describes the diagnosis carefully . overall good experience with the doctor. Undergone lithotripsy successfully....Read Less
Doctor in this story :Dr. Hiralal Chaudhari
Urology Clinic
Shilpa Gupta
Success With Lithotripsy
It was 1st week of December my wife got diagnosed with 1.3 mm stone in kidney. After we have discussed with many Doctors in Bangalore, we finally discussed with Dr Rajeev. He is very patient to listen all your problems and answer any random questions that is being asked, since we are a novice in this. He explains all the procedures available to cure this, with their Pros & cons. And we finally decided to start with Lithotripsy procedure (since its a non invasive process, and obviously more convenient than surgery). Though other places they told it would take 2-3 sittings of lithotripsy, for my wife it worked in 1st sitting only, that the stones got fragmented. Thanks to this world class technology used here and Dr Rajeev being himself monitoring it throughout the session. Its 1 month under his treatment and free of stones now. I definitely recommend Dr Rajeev for stone treatment. ...Read Less
Doctor in this story :Dr. Rajeev Bashetty
Matoshree Kidney Stone Center & UroNephro Clinic

Questions answered by trusted doctors

Verified User
I recently had a Lithrotripsy procedure to break up kidney stones. I was told I would be bleeding but I haven’t been. I haven’t passed anything yet but I’m in emmense pain, in the pelvic and back areas. It feels like someone is sitting on my back and feels like I am constantly getting the wind knocked out of me. Is this normal?
Dr. Chandraprakash Garg
Urologist, Ahmedabad
Go to my Web site
urologistdoctor.wordpress.com
Verified User
Can an Andrologist perform Lithotripsy in females perfectly. I want lithotripsy. But all r male Andrologist
Dr. Vijayant Govinda Gupta
Urologist, Delhi
Lithotripsy is performed by a urologist. Andrologist are urologists.

Yes all Andrologist who are urologists cab perform Lithotripsy effectively.

Verified User
My husband undergone Lithotripsy treatment 2 times for 6mm kidney stone its 4 day still stone has not passed out. What is the success rate and how long will it take.
Dr. Rohan Jaju
Andrologist, Mumbai
Success of eswl is around 60-70% also depends on location of stone And hardness of stone...have plenty of fluids..use syrup potrate MB6 two teaspoons three times a day for 1month...do exercises like jogging and jumping....
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Did you know?

Extracorporeal Shock Wave Lithotripsy (ESWL) and stone sizes

ESWL is highly effective for removing stones of size 4 mm to 2 cm. For stones which are less than 1cm a single ESWL process would be enough.

Cost of laser lithotripsy in India

The laser lithotripsy procedure for kidney stone removal in India costs between INR 2,00,000 to INR 2,50,000.

Shockwave Lithotripsy for Kidney Stones

Shock Wave Lithotripsy (SWL) is an efficient non-surgical procedure for treating stones in the kidney or the ureter. Once the stones are broken into fragments with targeted high energy shock waves, they easily pass through urine.

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