KIDNEY STONE TREATMENT: SHOCK WAVE LITHOTRIPSY

What is lithotripsy?
Lithotripsy is a non-invasive (the skin is not pierced) procedure used to treat kidney stones that are too large to pass through the urinary tract.  Lithotripsy treats kidney stones by sending focused ultrasonic energy or shock waves directly to the stone first located with fluoroscopy (a type of X-ray ‘movie’) or ultrasound (high frequency sound waves).   The shock waves break a large stone into smaller stones that will pass through the urinary system.

Additionally this procedure allows persons with certain types of stones in the urinary system to avoid an invasive surgical procedure for stone removal.  In order to aim the waves, your doctor must be able to see the stones under X-ray or ultrasound.

There are two types of shock wave technology– The original lithotripsy machines sent the shock waves through water in a tub in which the person being treated was placed.  This technology remains in use today.   More recently, machines have been developed that send shock waves through padded cushions on a table, so the procedure does not involve immersing a person in water.

Reasons for the procedure
When kidney stones become too large to pass through the urinary tract, they may cause severe pain and may also block the flow of urine.  An infection may develop.  Lithotripsy may be performed to treat certain types of kidney stones in certain locations within the urinary tract.

Other procedures that may be used to treat kidney stones include:

• Urethroscopy or ureteroscopy. Endoscopic procedures in which stones in the urethra or ureter may be removed with a device inserted through a short, flexible, lighted tube, called an endoscope.
• Percutaneous nephrolithotomy (tunnel surgery). A surgical procedure for stones that cannot be treated with lithotripsy or endoscopic procedures.  It involves the removal of a stone through a thin tube tunneled through a small incision in the back into the kidney.
• Open surgery. A more invasive surgical procedure using a larger incision to directly access the stone.
• Stent. A synthetic, tubular device that may be used along with other procedures. A stent may be inserted through a special scope into the urinary tract to allow stones to pass more easily.

About kidney stones
When substances that are normally excreted through the kidneys remain in the urinary tract, they may crystallize and harden into a kidney stone.  If the stones break free of the kidney, they can travel through, and get lodged in, the narrower passages of the urinary tract.  Some kidney stones are small or smooth enough to pass easily through the urinary tract without discomfort.  Other stones may have rough edges or grow as large as a pea causing extreme pain as they travel through or become lodged in the urinary tract.  The areas most prone to trapping kidney stones are the bladder, ureters, and urethra.

Most kidney stones that develop are small enough to pass without intervention. However, in about 20% of cases, the stone is greater than 2 centimeters (about one inch) and may require treatment.  Most kidney stones are composed of calcium; however, there are other types of kidney stones that can develop. Types of kidney stones include:

• Calcium stones. Calcium, a normal part of a healthy diet used in bones and muscles, is normally flushed out with the rest of the urine. However, excess calcium not used by the body may combine with other waste products to form a stone.
• Struvite stones. Struvite stones, composed of magnesium, phosphate, and ammonia, may occur after a urinary tract infection.
• Uric acid stones. Uric acid stones may occur when urine is too acidic, as in certain conditions, such as gout or malignancies.
  Cystine stones. Cystine stones consist of cystine, one of the building blocks that make up muscles, nerves, and other parts of the body.

Before the procedure
Dr. Bellman & knowledgeable staff will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.  You’ll be asked to sign a consent form that gives your permission to do the procedure.  Read the form carefully and ask questions if something is not clear.

In addition to a complete medical history, Dr. Bellman may perform a complete physical examination to ensure you are in good health before undergoing the procedure.

You may undergo blood tests or other diagnostic tests.  Fasting before the procedure may be indicated, depending on the type of anesthetic or sedation used.  You will also be given instructions on how many hours to fast before the procedure if necessary.

Based on your medical condition, Dr. Bellman may request other specific preparation.

After the procedure
After the surgery you will be taken to the recovery room for observation.  Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.

• You may resume your usual diet and activities unless advised differently.
• You will be encouraged to drink extra fluids to dilute the urine and reduce the discomfort of passing stone fragments.
• You may notice blood in your urine for a few days or longer after the procedure. This is normal.
• You may notice bruising on the back or abdomen.
• Take a pain reliever for soreness as recommended; Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
• You may be given antibiotics after the procedure. Be sure to take the medication exactly as prescribed.
• You may be asked to strain your urine so that remaining stones or stone fragments can be sent to the lab for examination.
• A follow-up appointment will be scheduled within a few weeks after the procedure.  If a stent was placed during the procedure, it may be removed at this time.

Please notify us right away to report any of the following:

• Fever and/or chills
• Burning with urination
• Urinary frequency or urgency
• Extreme lower back pain

 **Our office may give you additional or alternate instructions after the procedure, depending on your particular situation**