What Is Lithotripsy?

Lithotripsy is a general term used to describe methods of breaking up mineral stones in the body. Stones in these areas can cause pain, blockage of urine and lead to serious complications. Currently, the most used type of treatment, extracorporeal shock wave lithotripsy (ESWL), is applied from the outside of the body near the kidneys.

History

• Italian medical sources suggest lithotripsy may have been known as a treatment for kidney stones in the early 19th century, although it is difficult to see how ultrasonics could have been involved. There are even hints in the medical literature that an early Arabic surgeon, Abu'l Kasim Chalaf ben Abbas el-Zahrewi (c. 912-1013) knew about the process. By the mid-1980s, shock wave lithotripsy began to be accepted as the preferred way to dissolve kidney stones.

Types

• Three types of lithotripsy exist: ultrasonic, extracorporeal shock wave, and electrohydraulic. In the first procedure, a probe breaks up a stone into smaller pieces. In the second, an electronic probe is placed in the ureter. High-frequency sound waves then break up the stones. The electrohydraulic method uses electricity rather than ultrasound. In some cases, surgery may still be needed to remove larger fragments.

Benefits

• Using lithotripsy can avoid more serious surgical interventions, post-treatment complications and associated side effects. However, the appropriate choice of treatment depends upon the size of the stone, the type and the frequency of re-occurrence. Larger stones require more invasive methods but the end result may be more cost-effective. Lithotripsy is effective between 70 to 90 percent of the cases where it can be used.

Misconceptions

• Lithotripsy is not a treatment for all types of kidney stones. Multiple stones, location, composition and size may rule out this method of treatment.

Warning

• Any medical intervention, particularly invasive, involves risk. Some risks associated with this procedure are fragments remaining in the system, bleeding, tissue damage to surrounding areas, urinary blockages or infections. Damage and scarring of the kidney may lead to long-term problems. [Source: J.A. McAteer and A.P. Evan, "The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy," Seminars in Nephrology 28:2 (March 2008), 200-213.] Other problems include increased arterial blood pressure, decreased kidney function and more occurrences of stones. [Source: A.P. Evan et al., "Shock Wave Lithotripsy-Induced Renal Injury," American Journal of Kidney Diseases 17:4 (April 1991), 445-450.]

Theories/Speculation

• A study in 2006 found shock wave lithotripsy could increase the risk of both diabetes and hypertension. A 19-year follow-up of patients who received this treatment found diabetes developed 3.23 times as often as in a control group. Hypertension occurred 1.47 times as often. Researchers theorized the shock waves damaged the pancreas, leading to diabetes. The association with hypertension could be due to tissue changes in the kidneys. However, the study authors cautioned this very effective treatment should not be stopped at this point. [Source: Amy E. Krambeck et al., "Diabetes Mellitus and Hypertension Associated with Shock Wave Lithotripsy of Renal and Proximal Ureteral Stones at 19 Years of Follow-up," Journal of Urology 175:5 (May 2006), 1742-1747.]