Advantages and Disadvantages of Lithotripsy

When lithotripsy was introduced in the 1980s, it was a groundbreaking procedure. Treatment for kidney stones used to involve major surgery and general anesthesia. Lithotripsy changed that, becoming the only available non-invasive treatment for kidney stones. While it does not work for every patient, this treatment is still popular today.

Procedure

Lithotripsy uses a series of shock waves to break up kidney stones. An x-ray focuses the sound waves in the right area. The stones are vibrated into smaller pieces that can easily pass through the rest of the urinary system and out of the body.

Indications and Advantages

The biggest advantage of lithotripsy is that it is a non-invasive procedure. It carries far fewer risks than surgery, which requires an open incision. This procedure is best suited for people with small kidney stones that are easily visualized on an x-ray. This way, they can be accurately targeted during the procedure.

Indications

Not all kidney stones can be treated with shockwave lithotripsy. Generally, it depends on the number of stones, where they are located, and how big they are. Before the procedure, a CT scan determines the exact location and hardness of the stone, which can predict how likely the procedure is to succeed.

Effectiveness

Lithotripsy is effective between 70 and 80 percent of the time. The procedure is most successful for patients with kidney stones in the upper part of the urinary tract — that is, in the kidneys and the tubes that carry urine to the bladder. When the initial procedure is unsuccessful, patients may require endoscopic surgery.

Risks

Lithotripsy is a low-risk procedure, but it does have some possible complications, including bleeding around the kidney and kidney damage. It is also possible that the procedure successfully breaks apart the stones, but the pieces block the flow of urine or remain inside the body, which requires additional treatments.

Contraindications

Not everyone with kidney stones can get lithotripsy, even if the stones are in the right place and the right size. Patients who are pregnant, take blood thinners, or experience chronic kidney infections cannot get lithotripsy. Patients with scarring in the ureters must also avoid this procedure, as the scarring can prevent the stone pieces from passing. The makeup of the stone has an impact, too, as those made of cystine and calcium do not break down as well.

Limitations

Shockwave lithotripsy is generally well-tolerated, but it often requires multiple treatments for complete success. Patients with the best chance of eliminating the stones completely are carefully selected; many patients with kidney stones are not ideal candidates for the procedure. Lithotripsy is also not as effective on obese patients as the soundwaves have to travel through more tissue to reach the stones.

Pancreatic and Biliary Stones

In addition to kidney stones, lithotripsy can also treat pancreatic and biliary stones. Although this is not the most common approach for these types of stones, lithotripsy is useful for breaking up large or irregularly shaped growths. This approach is most effective when used in conjunction with stent placement, and extraction of large stone fragments may be required.

Laser Lithotripsy

Another type of lithotripsy is laser lithotripsy. This approach uses a holmium laser to remove stones anywhere along the urinary tract, including the kidneys, ureters, and urethra. This type of lithotripsy involves inserting a thin, flexible laser fiber into the urethra to break up the stones. It does not require any incisions and is generally low-risk.

Benefits and Risks of Laser Lithotripsy

Laser lithotripsy has some advantages over shock wave lithotripsy. Stone fragments are less likely to block the ureter with the former option, and it is more effective for people with multiple kidney stones. The big disadvantage is that laser lithotripsy requires general anesthesia, which translates to a longer time in the hospital, longer recovery, and increased costs.