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Kidney stones (nephrolithiasis)

Lithotripsy is a procedure used to break kidney stones or bladder stones into small pieces. That makes it easier to pass them in the urine. Renal stones, a term that includes both kidney and bladder stones, are small, hard mineral deposits that build up in the urinary tract. These stones are usually about the size of a pea. Most kidney stones pass through the ureters, the tubes leading from the kidneys to the bladder, into the bladder. But sometimes stones get stuck in the ureter or bladder and cause a painful obstruction. Obstruction can lead to infection, and serious kidney damage can result.

Other treatments for kidney stones include drinking lots of water and modifying the diet. Medications may be prescribed to keep new stones from forming and to treat infection.

Who is a candidate for the procedure?
Anyone who has kidney stones that have led to obstruction, infection, pain or serious bleeding may need lithotripsy. Sometimes large asymptomatic stones may be treated to prevent future problems.

How is the procedure performed?
One type of lithotripsy uses a machine called a lithotriptor. This procedure breaks up stones in the kidney or upper ureters. It uses shock waves to pulverise the kidney stones, breaking them into smaller fragments, which are then easier to pass in the urine. People are first given a general anaesthetic to make them sleep. X-ray machines are used to locate the stones so that the body can be positioned properly.

Shock waves are then sent through the body. The body is not usually harmed by the shock waves. But the renal stones are so brittle that they respond to the shock waves by breaking apart. X-rays are taken throughout the procedure to check on the status of the stones. Usually 2000 to 4000 shock waves are needed to break down the stone. People must wear protective headphones during this procedure because the shock waves produce a very loud sound. It usually takes about an hour, and no incision or hospitalisation is needed.

Stones that are can't be broken down by the lithotriptor may be broken down using other procedures. One of these procedures is percutaneous ultrasonic lithotripsy. In this procedure, a small incision is made in the skin and a special scope is passed through it into the kidney. A small instrument is used to shoot ultrasound waves at the stone. The stone fragments are then removed through the same scope.

Endoscopic lithotripsy is another variation of lithotripsy. A small instrument is passed through the bladder and into the ureter. Attached is a unit that uses ultrasound or shock waves to break down the stones.

In the past, a major operation was needed to remove stones from the ureters, kidney, or bladder. It usually took a long time to recover from this surgery.

What happens right after the procedure?
After lithotripsy, the person is monitored in the surgery recovery room as the anaesthesia wears off. Side effects of anaesthesia can include stomach upset and allergic reaction to the medications. People are encouraged to drink plenty of water to flush out the stone fragments from the urinary tract. They are also encouraged to walk. If an incision was made, the person is watched for bleeding and signs of infection.

What happens later at home?
Care at home depends on the type of lithotripsy. Antibiotics and anti-inflammatory medications may be used for a few days. People may be asked to strain the urine at home so any stones that are found can be sent to the laboratory for examination. Drinking plenty of water dilutes the urine, which makes new stones less likely in the future. People should watch for several symptoms. These include an excessive urge to urinate, blood in the urine, and gradual pain that moves down from the ribs toward the groin, as the stone moves down the urinary tract. The doctor should be contacted if these or any other unusual symptoms develop.

What are the potential complications after the procedure?
Complications include allergic reactions to the anaesthesia. There may be trace amounts of blood in the urine for a few days after lithotripsy. Sometimes the stone does not respond to lithotripsy, and further surgery may be needed. More stones may develop in the future.

Author: Eileen McLaughlin, RN, BSN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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