Patient education: Lithotripsy for kidney stones (The Basics)

What are kidney stones? — Kidney stones are just what they sound like: small stones that form inside the kidneys. They form when salts and minerals that are normally in urine build up and harden.

Kidney stones usually get carried out of the body when you urinate (figure 1). But sometimes, they get stuck on the way out. When a kidney stone is big, or causes severe symptoms, it needs treatment.

What is lithotripsy? — This is a procedure to break up kidney stones into smaller pieces. Lithotripsy does not involve surgery, but it can be painful.

Lithotripsy can be done in 2 ways: using shock waves or using lasers.

How do I prepare for lithotripsy? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●CT or MRI – These are imaging tests that create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during lithotripsy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●There are 2 main types of lithotripsy:

•Shock wave lithotripsy – The doctor places a special machine over the area of the kidney stone. The shock waves from the machine travel through your body to break up the kidney stone. You might have gel on your skin or lie on a special cushion to help the shock waves move through your body. You will pass the small pieces of the stone out of your body in your urine over the next few weeks.

•Laser lithotripsy – The doctor puts a thin tube with a tiny camera on the end into your urethra, and moves it up through your bladder and into your ureters. This tube is called a "ureteroscope." Then, the doctor can use a special laser to break up the kidney stone into smaller pieces. Often, the doctor can remove the small pieces of the stone during the procedure.

●The doctor might also place a "stent" in your ureter if needed. This is a small metal tube that holds your ureter open. If a stent was put in, it will stay in your ureter for a few days to a few weeks. The doctor will tell you exactly how long you need it. You will have a separate procedure to have it taken out.

●The procedure takes 1 to 2 hours to complete.

What happens after lithotripsy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

●The doctor might ask you to strain your urine by using a filter. This will collect the pieces of the stone when they come out. The doctor might want to run tests on the stone to learn more about it.

What are the risks of lithotripsy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Pain while pieces of the kidney stone pass

●Blocked urine flow if the stone fragments are too big to pass

●Injury to your kidney or ureter

●Urinary tract infection

●Blood in your urine

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Lithotripsy for kidney stones – Discharge instructions (The Basics)
Patient education: Kidney stones in adults (The Basics)
Patient education: Kidney stones in children (The Basics)
Patient education: Ureteroscopy (The Basics)
Patient education: Hydronephrosis in adults (The Basics)
Patient education: Polycystic kidney disease (The Basics)
Patient education: Blood in the urine (hematuria) in adults (The Basics)
Patient education: Abdominal pain (The Basics)

Patient education: Kidney stones in adults (Beyond the Basics)
Patient education: Kidney stones in children (Beyond the Basics)
Patient education: Polycystic kidney disease (Beyond the Basics)
Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)
Patient education: Blood in the urine (hematuria) in children (Beyond the Basics)
Patient education: Chronic abdominal pain in children and adolescents (Beyond the Basics)