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Lithotripsy / ESWL

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What is lithotripsy?

Lithotripsy is a medical procedure used to treat certain types of kidney stones and stones in other organs, such as your gallbladder or liver.

Kidney stones occur when minerals and other substances in your urine crystallize in your kidneys, forming solid masses, or stones. These may consist of small, sharp-edged crystals or smoother, heavier formations that resemble polished river rocks. They usually exit your body naturally during urination.

However, sometimes your body can’t pass larger formations through urination. This can lead to kidney damage. People with kidney stones may experience bleeding, severe pain, or urinary tract infections. When stones begin to cause these types of problems, your doctor may suggest lithotripsy.

How does lithotripsy work?

Lithotripsy uses sound waves to break up large kidney stones into smaller pieces. These sound waves are also called high-energy shock waves. The most common form of lithotripsy is extracorporeal shock wave lithotripsy (ESWL).

Extracorporeal means “outside the body.” In this case, it refers to the source of the shock waves. During ESWL, a special machine called a lithotripter generates the shock waves. The waves travel into your body and break apart the stones.

ESWL has been around since the early 1980s. It quickly replaced surgery as the treatment of choice for larger kidney stones. ESWL is a noninvasive procedure, which means it doesn’t require surgery. Noninvasive procedures are generally safer and easier to recover from than invasive procedures.

Lithotripsy takes about 45 minutes to an hour to perform. You’ll likely be given some form of anesthesia (local, regional, or general) so you don’t experience any pain.

After the procedure, stone debris is removed from your kidneys or ureter, the tube leading from your kidney to your bladder, through urination.

How to prepare for lithotripsy?

It’s important to tell your doctor about any prescription drugs, over-the-counter medications, or supplements you take. Certain drugs, such as aspirin (Bufferin), ibuprofen (Advil), and warfarin (Coumadin) or other blood thinners, can interfere with your blood’s ability to clot properly.

Your doctor will probably ask you to stop taking these medications well before the procedure. However, don’t stop taking drugs you’ve been prescribed unless your doctor tells you to.

Some people have lithotripsy under local anesthesia, which numbs the area to prevent pain. However, most people have the procedure under general anesthesia, which puts them to sleep during the procedure. If you’re going to be under general anesthesia, your doctor may tell you not to drink or eat anything for at least six hours before the procedure.

If you’re having ESWL under general anesthesia, plan for a friend or family member to drive you home after the procedure. General anesthesia may make you drowsy after lithotripsy, so you shouldn’t drive until the effects have fully worn off.

What to expect during lithotripsy?

Lithotripsy is usually done on an outpatient basis. This means that you’ll go to the hospital or clinic on the day of the procedure and leave the same day.

Before the procedure, you change into a hospital gown and lie on an exam table on top of a soft, water-filled cushion. This is where you remain while the procedure is performed. You’re then given medicine to sedate you and antibiotics to fight infection.

During lithotripsy, high-energy shock waves will pass through your body until they reach the kidney stones. The waves will break the stones into very small pieces that can easily be passed through your urinary system.

After the procedure, you’ll spend about two hours in recovery before being sent home. In some cases, you may be hospitalized overnight. Plan to spend one to two days resting at home after the procedure. It’s also a good idea to drink plenty of water for several weeks after lithotripsy. This will help your kidneys flush out any remaining stone fragments.

Risks of lithotripsy

Like most procedures, some risks are involved in lithotripsy.

You may experience internal bleeding and need a blood transfusion. You can develop an infection and even kidney damage when a stone fragment blocks the flow of urine out of your kidneys. The procedure can damage your kidneys, and they may not work as well after the procedure.

Possible serious complications may include high blood pressure or kidney failure.

Long-term outlook for people with kidney stones

The outlook is generally good for people with kidney stones. Recovery may vary depending on the number and size of the stones, but lithotripsy can usually remove them completely. In some cases, additional treatments may be needed. While lithotripsy works very well for most people, there’s a chance that the stones will return.

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