Why is lithotripsy necessary?

From your symptoms and the x-ray examination of your urinary symptoms we have found that you have a stone, or group of stones, in your urinary tract. These stones may lie in the tubes of the kidney or in the tube (ureter) that brings the urine from the kidney to the bladder. They are made from various materials that fall out of solution. They start as tiny grains and grow to become visible on the x-ray and cause you symptoms such as pain, infection or blood in the urine.

If these stones are left they will continue to grow and may damage the kidney because of infection or blockage of the tubes. If they move they can cause pain, which can be severe. The specialist has carefully looked at your x-rays and it is felt that you will benefit from getting rid of the stone using the lithotripsy machine.

What preparation is needed?

It is important that you drink plenty of fluid (one glass every hour) on the day of the test and the day after. If you think you may have a bladder infection you should let us know before the test.

You are welcome to bring your own dressing gown and slippers to the clinic to make yourself more comfortable.

Just before the procedure you will be asked to empty your bladder and given some painkillers.

If there is any chance that you might be pregnant you must tell one of the staff on the unit since the pressure waves and x-rays used may damage a developing baby. A pregnancy test on the day of treatment may be necessary.

How is lithotripsy done?

The lithotripsy machine generates waves of turbulence or pressure in the air. These can be passed through the body and will shatter urinary stones into tiny fragments that can easily be passed in the urine. To make them work they have to be focused onto the stone. We focus on the stone by pinpointing it with x-rays or ultrasound scans. The waves do not significantly damage the tissues they pass through. Lithotripsy is a way of getting rid of stones without an operation or an anaesthetic.

When you arrive in the lithotripsy suite, you will be asked to change into a hospital gown. Secure lockers are provided for you to store your clothes and belongings. The nurse on the unit will ask you some questions about your health and take a few simple measurements such as your blood pressure, you will also be asked to empty your bladder. You will be given a couple of painkiller tablets to take and may also have an x-ray taken to make sure that the stone hasn’t moved.

When the machine is ready you lie on the couch, usually on your back but sometimes on your front depending upon the position of the stone. The probe that generates the pressure waves will then be placed next to your skin with some jelly in between. The x-ray machine will move up and down over your body to pinpoint the stone.

Once everything is ready you will be given some painkiller through a small needle in your hand. If you have an infection you will also be given some antibiotics. Sticky pads will be put on your chest to measure your heartbeat. You can listen to some music. 

The machine is then started. The first pressure wave comes as a bit of a shock but you soon settle down as you get used to the strange feeling and the noise. The pressure waves are given in time to your heartbeat. The treatment is usually moderately uncomfortable, like being firmly tapped. As the treatment progresses the power is increased until you feel the discomfort has changed to a more painful feeling. The power is then reduced slightly and treatment continued at the same intensity. Most treatments last for 45 minutes to one hour. During treatment the stone will occasionally be pinpointed with the x-ray machine and the table position adjusted automatically.

After the treatment has finished you will be helped off the table and allowed to rest for a while before getting dressed. Once you have passed urine, you will be allowed home with some painkillers and a short course of antibiotics if you need them.

What will happen after the treatment?

• After the treatment you will feel a bit sore and will need to take simple painkillers such as paracetamol for a few days.
• If you had an injection of painkiller you cannot drive for 24 hours. 
• You may pass some blood and sand in the urine as the shattered stone comes out.

What problems may occur?

Lithotripsy does bruise the kidney slightly, which causes some blood in the urine. This is quickly cleared by drinking plenty. There is no evidence to suggest that any long-term damage will be caused to the kidney or any other organ by the pressure waves.

Sometimes bugs are released from the stone when it breaks up which may cause an infection in the urine or blood stream. If you do become feverish or shivery it is important that you get the infection treated by your GP, local hospital or back at the Freeman.

Usually the fragments of the disintegrated stone are small enough to pass out in your urine without discomfort. Larger pieces may get stuck in the tube between the kidney and bladder (ureter). This may cause you to feel pain and become unwell. Again you will need to get help from your GP, local hospital or come back to the Freeman. 

Is the treatment always successful?

The aim of the treatment is to get rid of all the stone visible on the x-ray and to get rid of your symptoms. You will be asked to come back to be seen a couple of weeks after your treatment. An x-ray will be taken and you will be seen by one of the staff. Larger or harder stones often need two or more sessions to break them up fully. Smaller stones usually need only one treatment but can take several weeks to clear completely.

The success rate varies according to the size, position and hardness of the stone. Small stones in the main kidney collecting tube (renal pelvis) have a 90% success rate whilst larger stones in the tubes of the lower parts of the kidney have a 60% success rate. Once we are happy that the stone has gone we will let your urologist and GP know.

Are there any alternatives?

Sometimes stones can be left alone if they are small, in the kidney and not causing any symptoms. There are no tablets that will dissolve stones although some can help to prevent new stones forming.

Stones in the tube between the kidney and bladder (ureter), especially the lower part, can be removed by passing a fine telescope into the bladder and up the tube. Miniturised lithotripsy probes can then be used to shatter the stone and the bits removed using tiny baskets.

Larger stones in the kidney tubes can be removed by passing a telescope into the kidney through a small hole in the back. The stone can then be shattered and the bits sucked out.

The specialist will have taken everything into account to decide the best treatment, but feel free to ask about the alternatives if you want to know more.

What can I do when I get home?

It is best to rest until the next morning after the treatment, but then you can resume full activities.

How can other questions be answered?

If there is anything you are unclear about, telephone the lithotripsy secretary on 0191 213 2062 or 0191 213 7556.