What Are The Main Disadvantages Of This Approach
Compared with other available techniques:
- Per treatment, is the least successful at achieving stone clearance in one session
- Treatment may require multiple sessions to achieve complete stone clearance
- Results more likely influenced by patient size, stone composition, and kidney anatomy
- Recent concerns regarding increased longer term risks of developing high blood person and diabetes remains an area of contention due to tissue injury to the kidney and pancreas.
What Is A Kidney Stone
A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy. Common symptoms include severe pain in lower back, blood in your urine, nausea, vomiting, fever and chills, or urine that smells bad or looks cloudy.
Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the bodys master chemist: the kidney. In most people, having enough liquid washes them out or other chemicals in urine stop a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine, and phosphate.
After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones move out of the body in the urine without causing too much pain. But stones that dont move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain.
Surgery For Kidney Stones
Although most kidney stones pass on their own, your doctor may decide that surgery is the best treatment if you have stones lodged in the ureters, the tubes that carry urine from the kidneys to the bladder large or particularly painful kidney stones stones causing an obstruction of urine flow or stones resulting in bleeding or infection.
At NYU Langone, our doctors also frequently treat people with more advanced kidney stone conditions, such as staghorn stones, which are large and can be caused by infection, and bilateral stones, which develop simultaneously in both kidneys or in the ureters.
Our surgeons perform hundreds of kidney stone surgeries each year, many of which involve minimally invasive techniques that do not require a hospital stay. In fact, traditional or open surgery, as it is commonly known, is now rarely performed at NYU Langone for the treatment of kidney stones.
The goal in any kidney stone surgery is to treat all stones at once. However, some people with kidney stones require a staged treatment approach in which more than one surgery is needed to reduce or clear the stones.
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Reducing Kidney Stone Risk
Drinking enough fluid will help keep your urine less concentrated with waste products. Darker urine is more concentrated, so your urine should appear very light yellow to clear if you are well hydrated. Most of the fluid you drink should be water. Most people should drink more than 12 glasses of water a day. Speak with a healthcare professional about the right amount of water thats best for you. Water is better than soda, sports drinks or coffee/tea. lf you exercise or if it is hot outside, you should drink more. Sugar and high-fructose corn syrup should be limited to small quantities.
Eat more fruits and vegetables, which make the urine less acid. When the urine is less acid, then stones may be less able to form. Animal protein produces urine that has more acid, which can then increase your risk for kidney stones.
You can reduce excess salt in your diet. What foods are high in salt? Everyone thinks of salty potato chips and French fries. Those should be rarely eaten. There are other products that are salty: sandwich meats, canned soups, packaged meals, and even sports drinks.
Some herbal substances are promoted as helping prevent stones. You should know that there is insufficient published medical evidence to support the use of any herb or supplement in preventing stones.
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What Is Kidney Stone Surgery
Kidney stone surgery involves a surgeon either physically removing a kidney stone whole or in pieces, or essentially blasting it apart so that it can be passed by the body.
This surgery may be scheduled or performed urgently by a urologista doctor who deals with diseases of the urinary tract.
There are different types of kidney stone surgeries. Depending on the one performed, you may go home the same day or stay in the hospital for one or more nights.
WASHINGTON, April 9 The use of shock waves to pulverize kidney stones into sand-like material significantly increases the risk for diabetes and high blood pressure later in life, according to the longest follow-up study of the popular therapy.
In the study, which is to be published on Monday from the Mayo Clinic, patients who underwent the pulverizing procedure, known as lithotripsy, developed diabetes at almost four times the rate of those whose kidney stones were treated by other methods. The lithotripsy group also developed high blood pressure about 50 percent more often than a group treated by other methods, the study in The Journal of Urology found.
The diabetes risk was related in part to the number of shocks given, said the Mayo Clinic researchers in Rochester, Minn. The risk for high blood pressure, also known as hypertension, was related to treatment of stones in both kidneys but not to the total number of shocks, which can number in the hundreds or thousands.
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Risks And Complications Of Eswl
ESWL is generally considered safe. The shock waves target the stones with precision and typically do not damage surrounding organs and tissues.
However, some groups of people have higher risk of complications after ESWL. Your doctor may advise against ESWL if you:
- Have a pacemaker or another implanted device that can be disrupted by the shock waves
- Take blood thinners or have a bleeding disorder
- You need the stones removed urgently and completely, which ESWL cannot guarantee
How To Prepare For Lithotripsy
Its important to tell your doctor about any prescription drugs, over-the-counter medications, or supplements you take. Certain drugs, such as aspirin , ibuprofen , and warfarin or other blood thinners, can interfere with your bloods ability to clot properly.
Your doctor will probably ask you to stop taking these medications well before the procedure. However, dont stop taking drugs youve been prescribed unless your doctor tells you to.
Some people have lithotripsy under local anesthesia, which numbs the area to prevent pain. However, most people have the procedure under general anesthesia, which puts them to sleep during the procedure. If youre going to be under general anesthesia, your doctor may tell you not to drink or eat anything for at least six hours before the procedure.
If youre having ESWL under general anesthesia, plan for a friend or family member to drive you home after the procedure. General anesthesia may make you drowsy after lithotripsy, so you shouldnt drive until the effects have fully worn off.
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Kidney Stone Causes And Risk Factors
Both men and women can get kidney stones, but menâs chances of getting them are about double that of womenâs.
Itâs often hard to figure out what caused a kidney stone. But they happen when your urine has high levels of certain minerals. These include:
If you donât have enough urine in your body to water down the high concentration of minerals, stones can form. Think about stirring up your favorite drink from a powder mix. If you donât add enough liquid say, water or juice the powder will clump up and turn into hard, dry chunks.
Things that can raise your risk for kidney stones include:
When Should I Call My Healthcare Provider
These symptoms are signs that a kidney stone may be blocking urine flow. Rarely, a blockage can lead to a serious infection that may pose a danger to your health.
- Blood clots in your urine.
- Dizziness or light-headedness.
A note from Cleveland Clinic
Shock wave lithotripsy is a safe treatment to get rid of kidney stones. Passing even tiny kidney stone fragments can hurt sometimes a lot. If you have shock wave lithotripsy, expect to feel some discomfort as stone fragments pass in the days and weeks after treatment. Pain may come and go until all the kidney stone pieces have worked their way out of your body. If you have other health issues, such as uncontrolled high blood pressure, shock wave lithotripsy may pose extra risks to you. Talk with your doctor about what to expect and whether shock wave lithotripsy is the right kidney stone treatment for your needs.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
References
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When Does A Kidney Stone Need To Be Treated
Most kidney stones pass on their own. But sometimes, a kidney stone becomes too big to move through the urinary tract. Pain during a kidney stone attack is typically due to a stone getting stuck in the ureter and blocking drainage of urine from the kidney. Kidney stones may cause health issues, such as kidney damage, blood in the urine or a severe infection. In these cases, treatment can help you safely get rid of kidney stones and feel better.
How Will I Feel After Surgery
Your doctor will prescribe medications after surgery. Generally, these may include an antibiotic to prevent infection, pain medication, and perhaps something to treat bladder spasms and burning with urination.
Drink plenty of water to lubricate the stent and encourage any small stones to move out of the kidney. You will likely feel a more frequent urge to urinate, so you may want to stay close to a bathroom.
You can resume normal activities the next day, or as soon as you feel comfortable. Skip high-intensity workouts until after your stent is removed. Some pain medications restrict activities like driving, so check the warnings on the label. Your doctor will have additional recommendations for you to follow.
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What Are The Risks Of Ureteroscopic Lithotripsy
All surgical procedures have risks, but complications are rare for this procedure. The most common side effects are:
- Pain when the stone particles pass. Dr. B-T will give you pain medication to go home with.
- Blood in your urine.
- Urinary blockage if particles get stuck in the ureter.
- Incomplete breakage and passage of stone fragments.
When Is Lithotripsy Used
Kidney stones are usually small enough to pass through the urinary tract along with urine. In some cases, the stones are too large to pass on their own. Lithotripsy is normally used when:
Stones are too large to pass Stones are blocking the flow of urine. Stones are causing bleeding or infection Pain medication isnt effective when trying to pass stones
Some stones may be too large to treat with shockwave lithotripsy. The size, shape, location, and the number of stones will all be evaluated to see if this procedure is appropriate.
Your doctor may advise alternate treatment if you are pregnant, weigh over 300 pounds, have a pacemaker, kidney cancer, kidney infection, or on medications for cardiac conditions.
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What Is Shock Wave Lithotripsy
Shock Wave Lithotripsy is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
These are what the words mean:
- extracorporeal: from outside the body
- shock waves: pressure waves
So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter using high-energy shock waves. Stones are broken into “stone dust” or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed
Reasons For The Procedure
The primary advantage of lithotripsy is that it is completely non-invasive.
Lithotripsy is well suited to patients with small kidney stones that can be easily seen by x-ray.
When kidney stones become too large to pass through the urinary tract, they may cause severe pain and may also block the flow of urine. An infection may develop. Lithotripsy may be performed to treat certain types of kidney stones in certain locations within the urinary tract.
There may be other reasons for your doctor to recommend lithotripsy.
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Risks And Side Effects
People often experience bruising and soreness after shock wave lithotripsy.
Fever or chills may occur after ureteroscopy and shock wave lithotripsy. These may indicate an infection, so a person should speak with a doctor if they experience fever or chills.
Heavy bleeding after lithotripsy is uncommon.
If stone fragments get stuck, there may be a blockage in the ureter. If this is the case, a doctor may perform an additional procedure with a ureteroscope to remove the fragments.
Prolonged pain may also indicate a blockage. If a person has severe pain or does not get relief from taking pain medications, they should contact a doctor.
New Kidney Stone Treatment Would Nudge Rather Than Blast
ByRachael Rettner20 October 2009
Passing kidney stones is often described as the worst pain people have ever experienced. Even worse, about half of kidney stone sufferers will get another stone within the following five years. Worse still, its often the initial treatment that leads to the subsequent stones.
But scientists are working on a new technique that could help prevent reoccurring kidney stones and maybe even get rid of smaller fragments before they become large and painful.
The technique involves using ultrasound waves to gently nudge stones toward the kidney exit. Testing in live pigs, whose kidneys are similar to ours, has shown success.
It just takes a flick, just a fraction of a second, we see the stone just jump in the kidney several centimeters, and sometimes it even bounces right out the door of the kidney, Michael R. Bailey from the University of Washington in Seattle. We have always been able to move the stones in each animal.
What they are
Kidney stones are crystallized mineral deposits that form inside the kidneys. They form when the basic elements that make up urine are out of balance. This can happen when there is not enough liquid to dissolve the minerals and salts, or if there is an abundance of these crystal-forming materials.
People who are dehydrated or who have certain metabolic conditions are prone to kidney stones.
Blasting vs. nudging
Other advantages
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What Can I Expect During A Shock Wave Lithotripsy Procedure
Your provider will not need to make any incisions during a shock wave lithotripsy procedure. But youll still need some form of anesthesia to keep you comfortable. You may be awake but drowsy or asleep during the procedure.
During a shock wave lithotripsy procedure:
What Other Treatment Choices Are Available
About 90 percent of stones pass through the urinary system without treatment. In cases where this does not occur, treatment to remove stones may be needed. Some stones may be dissolved by medicines. In other cases, one of the following methods of stone removal may be needed:
Percutaneous Stone RemovalWhen stones are quite large or in a location that does not allow effective lithotripsy, a technique called percutaneous stone removal may be used. In this method, the surgeon makes a small incision in the back and creates a tunnel directly into the kidney. A tube is inserted and the stone is removed through this tube.
Ureteroscopic Stone RemovalFor stones found in the lower part of the urinary tract, the doctor may pass a ureteroscope up into the bladder and ureter. A basket-like device may be passed through the tube to grasp and withdraw the stone.
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What If Shock Wave Lithotripsy Doesnt Work
In some cases, shock wave lithotripsy doesnt break up a stone enough for all pieces to pass on their own. If that happens, you may need another procedure.
Depending on your situation, your provider may recommend a second shock wave lithotripsy. Or your provider may suggest clearing any remaining stones through a minimally invasive procedure called ureteroscopy. Talk to your healthcare provider about the different types of kidney stone treatments.
What You Need To Know
- ESWL is a noninvasive procedure that breaks down stones in parts of the urinary system, in the pancreas and in the bile ducts.
- It uses shock waves that are aimed at stones, with the help of X-rays or ultrasound.
- Stones in the kidneys and ureter often pass on their own after EWSL.
- Stones in other locations, such as the pancreatic duct, may need to be extracted with an endoscope that can trap and remove stones.
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