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Lithotripsy is a procedure that is performed when you have gallstones, kidney stones or stones in your bladder or urethra. It is used when medications haven't worked to break the stones down and when it is a viable alternative to having surgery. It is generally performed as an outpatient procedure, although in some cases an overnight stay is required. Although there are some risks involved, when a lithotripsy works it provides tremendous relief for a painful, potentially dangerous condition.

Definition


Lithotripsy is sometimes referred to as ESWL, which stands for Extra Corporeal Shockwave Lithotripsy. Extra Corporeal means outside of the body, which is the biggest benefit of the procedure; it is completely non-invasive and is often performed without anesthesia. The shockwaves are actually ultrasound waves which penetrate the body harmlessly and break up the stones.


Gall stones and kidney stones are crystalline concretions; gallstones are made from the bile in the gall bladder, while kidney stones are composed of nutritional minerals. When these are small they pass out of the body through the urine, but if your kidney or gall bladder has an unusual shape, or if the stones become too big, they become painful and often lodge in the organ itself or the urethra, blocking urine behind them. When you go in for a lithotripsy, you prepare for the procedure by abstaining from food and drink for several hours, arrive at the facility where the procedure will take place and dress in a surgical gown. A pain killer and sedative will be administered along with an antibiotic to prevent infection, and you will be set up on a water-filled cushion on top of a surgical table.


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The lithotripsy tech will direct the shockwaves through your body, aiming the ultrasound waves directly at the stones. You will feel a tapping sensation as the force of the pulsing ultrasound waves breaks the stones into smaller pieces, which can then more easily pass out of your body through your urine.


The process takes about an hour, and sometimes a small tube will be inserted into your kidney to help with the draining process. Most people go home just a few hours after the procedure.

Risks


Although lithotripsy is highly effective, it does have risks, which include not getting all of the stones and needing to repeat the procedure, ulcers in your intestines or stomach, kidney infection, and tissue damage in the areas where the waves were directed. The procedure's success often depends on the number of stones that you have, the size of the stones and where they are located. The most successful procedures are those that are done for stones that are less than 20 millimeters in size.


Recent studies have shown that patients who reported bruising and tissue damage are more likely to have had procedures where the technologist gave fast bursts of shockwaves interrupted by a pause in the midst of the process. The American Urological Association released a study in 2009 stating that outcomes are much better, with better breaking down of the stones and less painful bruising, when the shockwaves are administered at a rate of 60 pulses per minute rather than 120 pulses per minute. Other studies warn of specific risks with elderly patients involving new-onset hypertension.

Cost


The cost of a lithotripsy procedure depends upon where it is being performed and how extensive your procedure's requirements are, but it is much less expensive than the cost of surgery, which involves many more medical personnel, higher administrative, surgical and anesthesia costs, and generally requires an overnight stay. Concerns about the cost of the procedure can probably be put to rest with a discussion with your insurer.

Lithotripsy

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