Lithotripsy: Non-invasive Treatment for Kidney Stones

Kidney stones can be very painful. They need treatment in about 20% of cases when they’re over 2 centimeters (about one inch) in size. Lithotripsy is a treatment without surgery. It sends shock waves to break stones so they can leave the body through urine.

Lithotripsy is used when stones are too big to pass naturally. This method focuses sound waves right on the stone to break it. This lets patients avoid big surgeries. Since the 1980s, lithotripsy has been changing how we treat kidney stones.

Key Takeaways

• Lithotripsy is a non-invasive procedure that uses shock waves to break up kidney stones.
• Lithotripsy allows patients to avoid major surgery for kidney stone removal.
• Complications of lithotripsy may include bleeding, infection, and obstruction of the urinary tract.
• Lithotripsy is recommended for patients with small kidney stones that are easily visible on x-ray.
• Extracorporeal shock wave lithotripsy (ESWL) is the most common type of lithotripsy procedure.

What is Lithotripsy?

Lithotripsy is used to treat big kidney stones without surgery. It is safe because it doesn’t cut the body. Lithotripsy uses sound or shock waves to target the kidney stone. This breaks the stone into small pieces that the body can naturally get rid of. It saves people from having surgery to take out kidney stones.

Advantages of Non-Invasive Treatment

The key benefit of lithotripsy is it is very safe. No cuts or inserting tools are needed. Patients can avoid the dangers and long recovery of surgery to remove kidney stones.

How Lithotripsy Works

For the lithotripsy procedure, the patient lies on a special table. There’s a lithotripter and imaging tools in the room. The doctor uses X-rays and maybe ultrasound to find the kidney stone‘s location. Shock waves are then aimed at the stone. These shock waves break the stone into small parts that can be peed out.

Types of Kidney Stones

Kidney stones come in different forms. The most common is made of calcium. Too much calcium the body doesn’t use can mix with waste. This forms calcium stones.

Patients can also get other kinds of stones. Each type is different.

Calcium Stones

Calcium stones are very common, making up to 80% of all stones. They form when there’s too much calcium in urine. This mixes with oxalate or phosphate.

Many things can lead to calcium stones. These include diet, family history, and certain health conditions.

Struvite Stones

Struvite stones are made of magnesium, ammonium, and phosphate. They often follow a urinary tract infection. These stones can get big fast.

If they become large, they might block the urinary tract. Surgery might be needed to remove them.

Uric Acid Stones

Uric acid stones appear when urine is very acidic. This happens with gout or some cancers. Men and those eating lots of purines can get these stones.

Cystine Stones

Cystine stones are rare and caused by a genetic issue. This problem makes too much cystine in the urine. Cystine stones can be hard to treat.

Special therapies may be needed for cystine stones. Their treatment is unique.

How the Urinary System Works

The urinary system takes care of liquid waste in our blood. It changes it to urine. This system also makes sure our blood has the right balance of salts and other things. The key parts are the kidneys, ureters, bladder, and urethra.

Kidneys

The kidneys clean the blood by taking out waste and extra water. Then, they make the urine to push it to the bladder.

Ureters

The ureters move the urine from the kidneys to the bladder. They are like tubes for urine.

Bladder

The bladder holds the urine until we are ready to get rid of it. A healthy adult bladder can hold up to two cups of urine for a few hours.

Urethra

The urethra lets the urine out of our body. This helps our body balance chemicals and water and get rid of waste.

Reasons for Lithotripsy

Lithotripsy is great because it doesn’t cut into you. This is perfect for people with tiny kidney stones. These stones show up well on x-rays.

Non-Invasive Advantage

Lithotripsy is a big plus because it’s non-invasive. Patients don’t have to worry about the risks of surgery. They also recover faster, making it a good choice for many.

Treating Large Kidney Stones

If kidney stones get too big, they can cause trouble. They might block urine and cause infections. Lithotripsy can break these big stones into smaller pieces. This helps the body get rid of them without trouble.

Preventing Complications

Lithotripsy breaks up big stones to avoid big problems. This includes blockages and infections. It’s an easy way to treat kidney stones without surgery. So, patients get better faster and with less risk.

Risks and Contraindications

Lithotripsy is mostly safe. Yet, patients should know some risks. Exposure to radiation is a key concern. It can add to a patient’s radiation exposure over time. Also, bleeding and infection are possible after treatment.

Obstructions and Scar Tissue

People with ureter obstructions or scar tissue may not be good for lithotripsy. This is because stone pieces might not pass through. For them, treatments like ureteroscopy might be better.

Stone Composition and Size

The type and size of the stones affect lithotripsy’s success. Some stone kinds, like cystine or brushite, can be hard to break. Large stones might need more than one session or a different treatment.

Bleeding and Infection

There’s a small chance of bleeding and infection after lithotripsy. Those with bleeding problems or on blood thinners have more risk. Picking the right patients and watching them can reduce this risk.

Radiation Exposure

Fluoroscopy and X-rays for lithotripsy carry a small radiation dose. With many sessions, this can increase lifetime radiation risk. Doctors try to use as little radiation as needed. But patients should talk about their risks with their doctor.

Knowing the risks helps patients choose their treatment wisely. It’s important to work with their healthcare team for the best care of their kidney stones.

Preparing for Lithotripsy

Before you get ready for lithotripsy, there are steps you might need to follow. For instance, stopping blood thinners or certain drugs could be necessary. Also, if you have kidney issues or blockages in your urine path, lithotripsy might not be for you. In such cases, looking into other treatment choices is wise.

When getting ready for lithotripsy, tell your doctor about all your meds. This includes herbal products and blood thinners. Doing so avoids problems and makes the treatment safer.

Remember, you might need to avoid eating or drinking before your lithotripsy. This is to stop the surgery from being canceled. And, because of the meds used, it’s a must to have someone drive you home afterwards.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) helps treat kidney stones. It uses shock waves from outside the body. These are aimed at the stone to break it into smaller pieces. Then, these pieces can leave the body through urine.

How ESWL Works

In the ESWL method, a special device sends high-energy shock waves. They’re focused right on the kidney stone. The waves travel through your skin and body harmlessly. But, they break the stone into tiny parts that can be peed out.

Stone Composition and Location Considerations

Yet, ESWL might not work for all stones. Stones made of cystine or uric acid, for example, can resist breaking with shock waves. Also, stones in tough-to-reach areas might not respond well to ESWL. In these cases, doctors might suggest other treatments.

ESWL for Pancreatic Duct Stones

ESWL helps with stones not just in the kidneys but also in the pancreatic duct. When the pancreas gets scarred and inflamed, it may form stones. These stones can cause pain and stop the flow of digestive juices.

Chronic Pancreatitis and Duct Stones

For big pancreatic duct stones, ESWL is a key treatment. It uses shock waves to crush the stones into tiny pieces. This makes it easier for the pieces to pass through the duct.

Combined with ERCP

ESWL is usually done with ERCP. This is a procedure where a tube with a camera goes through your mouth and into the pancreas. After ESWL, doctors can remove the stones or help the duct drain with a stent. This mix of ESWL and ERCP helps a lot with managing pancreatic duct stones and the issues they cause with chronic pancreatitis.

ESWL for Bile Duct Stones

For over 20 years, ESWL has been helping with bile duct stones. These are stones in the area where bile flows through. Sometimes, stones from the gallbladder get stuck here. While a surgery called endoscopic procedure is often used to remove them, ESWL can also help. It can break big or hard-to-reach stones, which makes them easier to take out.

In 2008, rules on managing bile duct stones were set. Since then, many studies have looked at how good ESWL is for them. One study checked 219 people using ultrasound and another method. They found the risks of surgery on these stones. Another study showed that ESWL can help when endoscopy can’t remove the stones.

Research with 53 patients found success using ESWL on hard-to-remove stones. Another study, over five years, also had good results. It showed that ESWL could help even when other ways didn’t work.

In tough cases, like stones inside the liver, a 10-year study with 55 patients showed promise. Another study looked at ESWL for gallstones. It also discussed an older surgery method in some people with these stones.

A special fluid called methyl tert-butyl ether has been used for some patients with no-clear stones. Another study looked at two ways to break up these stones. They compared how well a laser works inside the body to breaking them up from the outside.

The Lithotripsy Procedure

The lithotripsy procedure uses high-tech tools to break down kidney stones. It does so without needing surgery. A patient rests on a special table. This table is in a room with a lithotripter machine and advanced imaging tools.

Anesthesia

First, the patient gets anesthesia for a painless procedure. The type of anesthesia depends on what’s best for the patient and the procedure’s difficulty.

Stone Localization

The doctor finds the kidney stone precisely using special X-rays and sometimes ultrasounds. This step is very important to aim the shock waves correctly at the stone.

Shock Wave Delivery

Next, shock waves are targeted right at the stone. These waves are fine-tuned to break the stone into tiny pieces. This makes it easier for them to pass through the body.

Risks and Complications of ESWL

ESWL is mostly safe but has risks. Pregnant women and those with pacemakers should avoid it. The shock waves might harm a baby or the pacemaker.

Pregnancy and Implanted Devices

ESWL might not be good for pregnant women or those with pacemakers. The high-energy waves could be harmful. In such cases, other treatments should be considered.

Bleeding Disorders

If you have a bleeding disorder or are on blood thinners, ESWL is riskier. It might cause more bleeding. You may need extra care during the treatment.

Urgent Stone Removal

ESWL is not the fastest way to remove big stones. It breaks them into smaller ones, but not always all of them. For a quick and complete removal, other methods are better.

Lithotripsy Success Rates

Lithotripsy’s success rate changes based on the stone’s size, place, and what it’s made of. It works really well for small stones that show up clearly in pictures. But, it might not work as well for bigger stones or those with hard-to-break materials. Who does the procedure matters too.

Reaching stone-free status or just tiny bits of it left under 4 mm is winning against kidney stones. On average, stones were about 9.68 ±3.10 mm big, with a BMI of 24.3 ±2.67 kg/m².

After lithotripsy with sound waves, patients needed it about 1.7 ±1.36 times. Smaller stones, 10 mm or less, saw almost total success at 99%. But for larger stones, this rate dropped significantly to 9.4%. By the second round of treatment, 77% got rid of their stones, and as a whole, 82.6% succeeded.

Certain things affect if the stone goes away with ESWL. This includes how well your kidneys work and how many shockwaves you need. The odds are best if you have a smaller stone. The more you understand these factors, the better your treatment could be.

The stone’s location also plays a part in how well lithotripsy works. For stones in certain parts of the tube between the kidney and bladder, success is higher at 82% to 90%. But if the stone is nearer to the kidney, the rate is only 58% to 67%. Some stones even go away on their own up to half the time if they’re in the easier-to-reach area.

Many things can sway the success of ESWL, from how big the stone is to your body shape and even if you have a temporary tube inside you. How fast and hard the shockwaves hit also matters. But when everything is taken into account, success often comes with the right care and a bit of luck.

Alternative Treatments

Lithotripsy, the main non-invasive treatment for kidney stones, isn’t the only choice. Patients have other treatments to pick from. These choices depend on stone size, their where, what they’re made of, and the patient’s health and wishes.

Ureteroscopy

Ureteroscopy uses a small, bendy telescope through the urethra. It goes into the ureter or kidney to treat stones. The urologist can take out or break up stones. They use things like laser lithotripsy to do it.

Percutaneous Nephrolithotomy

PCNL is for big or tricky kidney stones. It’s a surgery where a tiny cut is made in the back. Then, doctors go into the kidney to take out the stones. This method is more direct than others but it works well for some stones.

Open Surgery

Sometimes, open surgery is needed for stones that can’t be removed otherwise. It needs a big cut to reach the kidney. Open surgery is for very tough cases. It might take longer to heal from compared to other treatments.

Stents

Stents are tubes that go in the urinary tract. They help with stone bits passing. Doctors use stents before or after other treatments. This makes those treatments work better.

Conclusion

Lithotripsy is a fancy word for a cool way to treat kidney stones without surgery. It uses shock waves to break up the stones into tiny pieces. This way, people can get better faster without a big operation. It’s a safe and popular choice for many with kidney stones.

Since being used in the 1980s, lithotripsy has changed how we treat kidney stone patients. Over the years, we’ve learned a lot about how well patients respond to this method. It works best for those with small stones that show up on x-rays. For them, it’s often the best and easiest way to get rid of the stones.

Scientists are still working to make lithotripsy even better. They’re searching for ways to boost the treatment’s success. They’re looking at how the type of stone and patient’s traits affect the results. By improving the shock wave’s strength and timing, they hope to make lithotripsy work even smoother in the future.

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