What is Lithotripsy

Lithotripsy is a treatment that can sometimes help eliminate kidney stones and the pain that they cause. A form of lithotripsy, also known as extracorporeal shock wave lithotripsy, is a nonsurgical procedure that crushes a kidney stone with shock waves.

These shock waves pass through your body and focus on the kidney stone. They cause the kidney stone to break up while it is still in the urinary tract. This makes it easier for the smaller pieces of stone to pass in the urine.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Any problems you or family members have had with anesthetic medicines.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding of the kidney.
• Bruising of the kidney or skin.
• Scarring of the kidney, which can lead to:
  • Increased blood pressure.
  • Poor kidney function.
  • Return (recurrence) of kidney stones.
• Damage to other structures or organs, such as the liver, colon, spleen, or pancreas.
• Blockage (obstruction) of the the tube that carries urine from the kidney to the bladder (ureter).
• Failure of the kidney stone to break into pieces (fragments).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines and other NSAIDs can thin your blood. Do not take these medicines for 7 days before your procedure if your health care provider instructs you not to.
• You may have tests, such as:
  • Blood tests.
  • Urine tests.
  • Imaging tests, such as a CT scan.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins. This tube will give you fluids and medicines.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A water-filled cushion may be placed behind your kidney or on your abdomen. In some cases you may be placed in a tub of lukewarm water.
• Your body will be positioned in a way that makes it easy to target the kidney stone.
• A flexible tube with holes in it (stent) may be placed in the ureter. This will help keep urine flowing from the kidney if the fragments of the stone have been blocking the ureter.
• An X-ray or ultrasound exam will be done to locate your stone.
• Shock waves will be aimed at the stone. If you are awake, you may feel a tapping sensation as the shock waves pass through your body.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You may have an X-ray to see whether the procedure was able to break up the kidney stone and how much of the stone has passed. If large stone fragments remain after treatment, you may need to have a second procedure at a later time.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may be given antibiotics or pain medicine as needed.
• If a stent was placed in your ureter during surgery, it may stay in place for a few weeks.
• You may need strain your urine to collect pieces of the kidney stone for testing.
• You will need to drink plenty of water.
• Do not drive for 24 hours if you were given a sedative.

Summary

• Lithotripsy is a treatment that can sometimes help eliminate kidney stones and the pain that they cause.
• A form of lithotripsy, also known as extracorporeal shock wave lithotripsy, is a nonsurgical procedure that crushes a kidney stone with shock waves.
• Generally, this is a safe procedure. However, problems may occur, including damage to the kidney or other organs, infection, or obstruction of the tube that carries urine from the kidney to the bladder (ureter).
• When you go home, you will need to drink plenty of water. You may be asked to strain your urine to collect pieces of the kidney stone for testing.

Lithotripsy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some blood in your urine. This should only last for a few days.
• Soreness in your back, sides, or upper abdomen for a few days.
• Blotches or bruises on your back where the pressure wave entered the skin.
• Pain, discomfort, or nausea when pieces (fragments) of the kidney stone move through the tube that carries urine from the kidney to the bladder (ureter). Stone fragments may pass soon after the procedure, but they may continue to pass for up to 4–8 weeks.
  • If you have severe pain or nausea, contact your health care provider. This may be caused by a large stone that was not broken up, and this may mean that you need more treatment.
• Some pain or discomfort during urination.
• Some pain or discomfort in the lower abdomen or (in men) at the base of the penis.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
• Do not drive or use heavy machinery while taking prescription pain medicine.

Eating and drinking

• Drink enough water and fluids to keep your urine clear or pale yellow. This helps any remaining pieces of the stone to pass. It can also help prevent new stones from forming.
• Eat plenty of fresh fruits and vegetables.
• Follow instructions from your health care provider about eating and drinking restrictions. You may be instructed:
  • To reduce how much salt (sodium) you eat or drink. Check ingredients and nutrition facts on packaged foods and beverages.
  • To reduce how much meat you eat.
• Eat the recommended amount of calcium for your age and gender. Ask your health care provider how much calcium you should have.

General instructions

• Get plenty of rest.
• Most people can resume normal activities 1–2 days after the procedure. Ask your health care provider what activities are safe for you.
• If directed, strain all urine through the strainer that was provided by your health care provider.
  • Keep all fragments for your health care provider to see. Any stones that are found may be sent to a medical lab for examination. The stone may be as small as a grain of salt.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that is severe or does not get better with medicine.
• You have nausea that is severe or does not go away.
• You have blood in your urine longer than your health care provider told you to expect.
• You have more blood in your urine.
• You have pain during urination that does not go away.
• You urinate more frequently than usual and this does not go away.
• You develop a rash or any other possible signs of an allergic reaction.

Get help right away if:

• You have severe pain in your back, sides, or upper abdomen.
• You have severe pain while urinating.
• Your urine is very dark red.
• You have blood in your stool (feces).
• You cannot pass any urine at all.
• You feel a strong urge to urinate after emptying your bladder.
• You have a fever or chills.
• You develop shortness of breath, difficulty breathing, or chest pain.
• You have severe nausea that leads to persistent vomiting.
• You faint.

Summary

• After this procedure, it is common to have some pain, discomfort, or nausea when pieces (fragments) of the kidney stone move through the tube that carries urine from the kidney to the bladder (ureter). If this pain or nausea is severe, however, you should contact your health care provider.
• Most people can resume normal activities 1–2 days after the procedure. Ask your health care provider what activities are safe for you.
• Drink enough water and fluids to keep your urine clear or pale yellow. This helps any remaining pieces of the stone to pass, and it can help prevent new stones from forming.
• If directed, strain your urine and keep all fragments for your health care provider to see. Fragments or stones may be as small as a grain of salt.
• Get help right away if you have severe pain in your back, sides, or upper abdomen or have severe pain while urinating.