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What is lithotripsy?
Kidney stones can form when materials that are usually eliminated by the kidneys stay in the urinary tract and solidify. Kidney stones can pass through the urinary tract painlessly because they are smooth or tiny enough. Some stones can be extremely painful to pass through or become trapped in the urinary tract. They can also have sharp edges or get as big as a pea. Kidney stones commonly trap themselves in the bladder, ureters, and urethra. When these stones grow large enough to travel through the urinary tract, doctors use a noninvasive procedure called lithotripsy to treat them.
The majority of kidney stones that form are tiny enough to pass through naturally. In almost 20% of cases, the stone is larger than 2 cm (about an inch) and may require treatment. Although kidney stones can have various forms, most are composed of calcium.
Kidney stone treatment with lithotripsy involves the direct application of focused ultrasonic energy or shock waves, initially detected by fluoroscopy or ultrasound. Thus, it can pass through the urinary system because the shock waves shatter them into smaller fragments. With lithotripsy, patients with specific kinds of kidney stones can avoid invasive surgery to remove the stone.
Types of kidney stones
- Stones that are made of calcium: The regular excretion of calcium along with the remainder of the urine is due to its normal utilization in bones and muscles as part of a healthy diet. But extra calcium that the body doesn’t need can join with other waste materials to form a stone.
- Stones with struvite: Magnesium, phosphate, and ammonia-containing struvite stones can develop following a urinary tract infection.
- Uric acid stones: When urine is highly acidic, uric acid stones may develop.
- Stones that are made of cystine: Cystine stones are made of cystine, which is a component of muscles, nerves, and other body parts.
The shock waves penetrate the skin and tissue of the body before reaching the stone and shattering it into tiny pieces. Following treatment, the body eliminates those tiny particles through the urine over a few weeks.
Lithotripter
A lithotripter is a noninvasive device that works by applying electromagnetic shock to a patient while they sit in a water bath, breaking up kidney stones. The lithotripter offers a non-invasive way to break up stones into tiny enough fragments for the patient to pass them naturally through their urine.
A lithotripter is a medical device designed to treat kidney stones by using shock waves to break them into smaller, passable fragments. The process, known as extracorporeal shock wave lithotripsy (ESWL), involves targeting the kidney stones with high-energy shock waves from outside the body. These waves travel through the skin and tissue to reach the stones, causing them to fragment. The urinary tract can then naturally expel the broken pieces. Lithotripters offer a non-invasive solution for kidney stones, reducing the need for surgical intervention and minimizing recovery time.
Various lithotripsy techniques
What is percutaneous lithotripsy?
The process makes an opening that runs from the back to the kidney. A surgeon uses specialized instruments, inserted through a tiny tube in your back, to find and remove kidney stones. The most common uses for percutaneous nephrolithotomy are for bigger stones or when less invasive methods are not feasible or effective.
Intracorporeal lithotripsy
In urology, intracorporeal lithotripsy continues to grow as the most popular surgical technique for treating stones. Ultrasonic, ballistic, combination lithotripters, laser, and electrohydraulic lithotripters are the five main types of intracorporeal lithotripters.
The procedure introduces a specialized needle into the kidney’s calyx, the chamber that collects urine. The process then continues through the needle’s path.
This treatment uses X-ray, CT, or ultrasound images to guide the needle’s placement. A flexible tube called a catheter travels through the urethra, bladder, and ureter to reach the kidneys. A specialized tracer substance can be injected into the kidney during imaging to better visualize its internal structures. Alternatively, the surgeon can thread a tiny camera through the catheter to see where the needle is placed and carry out other tasks.
Using specialized instruments, the surgeon breaks up and removes the stones through the sheath after inserting a tube or sheath along the needle’s path. Afterward, a separate tube known as a nephrostomy tube may be implanted using the same pathway. This may allow urine to flow directly from the kidney into an external bag throughout the healing process. The nephrostomy tube allows access to the kidney for additional stone removal if necessary in complex circumstances.
Electrohydraulic Lithotripsy (EHL)
It can be rather painful to pass stones that form in the bile or pancreatic ducts. High-energy shock waves can occasionally break apart stones through a process known as electrohydraulic lithotripsy (EHL). Instead of requiring surgery, doctors frequently use EHL with a Spyglass implementation to endoscopically break apart large stones.
What is an ultrasonic lithotripsy?
Ultrasound is non-ionizing radiation, and it produces mechanical vibrations. Consequently, ultrasonic lithotripsy can be used in numerous delicate situations where X-rays could be harmful. A rigid metal probe sends high-frequency vibrations from the source to the stone. At the point where the metal transducer’s tip comes into contact with the stone, fragmentation happens. Focused ultrasound blasts produce shock waves that destroy kidney stones.
What is laser lithotripsy?
The tiny size and flexibility of the optic fibers used for transferring energy make laser lithotripsy particularly well-suited for child care. Currently, lithotripsy employs two laser sources: the holmium-yttrium-aluminum-garnet (YAG) laser and the pulsed-dye laser.
To break up the stone, the pulsed-dye laser creates an acoustic shock wave that works like a hammer. Adjacent soft tissue is not at risk, but everyone in the room needs to wear safety glasses since unintentional exposure to the laser beam can cause irreversible retinal damage.
Another pulsed laser that uses thermal effects to make it effective is the holmium-YAG laser. Compared to pulsed-dye lasers, it is especially useful for cystine stones and yields smaller fragments. In the event of an unintentional encounter, there is no danger of ocular growth. However, the thermal effect could thermally affect the guidewires and the nearby ureteral wall.
Ballistic lithotripsy
Ballistic lithotripsy needs a rigid, straight ureteroscope with a minimum working channel of 3F. It is based on a pure mechanical hammer action conveyed along a 0.8-mm probe. Since it lowers the quantity of energy delivered, any incurvature of the probe should be avoided. The surrounding soft tissues are safe while using ballistic lithotripsy.
ShockPulse-SE (Stone Eliminator)
A single probe that combines mechanical and ultrasonic energy simultaneously can quickly break up stones of various kinds. Management of kidney, ureter, and bladder stones is safer and more efficient thanks to the large lumen and simple one-handed handling.
Benefits
- Excellent Speed and Efficiency: Aspirates and fragments stones of different compositions, sizes, and forms with effectiveness.
- Sensational Surgeon Management: Combined hand activation and suction with a comfortable handpiece
- Versatile: Wide selection of sizes and probes for the kidney, ureter, and bladder
Advantages of Lithotripsy
- Patients with little kidney stones that are easily visible on an x-ray are suitable patients for lithotripsy.
- Kidney stones can obstruct the flow of urine and cause extreme discomfort when they get too big to pass through the urinary stream. There could be an infection. Lithotripsy can be used to treat kidney stones located at specific areas of the urinary tract.
What are the complications of lithotripsy?
The following are possible lithotripsy complications:
- Bleeding around the kidney
- Infection
- Obstruction of the urinary tract
- Remaining stone pieces that would need more lithotripsies
Contraindications for lithotripsy include
- Patients who are pregnant
- Individuals with bleeding disorders or those on “blood thinners” must stop aspirin or other blood thinners before lithotripsy.
- Patients with persistent kidney infections may not fully eradicate the bacteria from their kidneys because certain fragments may not pass.
- Individuals with blocked ureters or scar tissue may be unable to pass stone particles.
- Patients who need to have all stones removed either immediately or completely.
- Individuals who have stones made of cystine and specific forms of calcium, since these stones are difficult to break apart with lithotripsy
- Patients should let their doctor know if they have a cardiac pacemaker. Pacemaker-wearing patients may undergo lithotripsy with a cardiologist’s approval and with appropriate safety measures. Lithotripsy can cause harm to pacemakers that are implanted in the abdomen and are rate-responsive.
- Intestinal gas and obesity can cause problems during a lithotripsy procedure.
Sources
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lithotripsy#:~:text=Lithotripsy%20involves%20the%20administration%20of,ray%20onto%20the%20kidney%20stone
- https://www.news-medical.net/Clinical-and-Diagnostics/Lithotripters
- https://www.kidney.org/kidney-topics/lithotripsy
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- https://www.britannica.com/science/ultrasonics/Medical-applications
- https://www.sciencedirect.com/topics/nursing-and-health-professions/ultrasonic-lithotripsy
- https://pubmed.ncbi.nlm.nih.gov/28608192/
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Written by Snegkha S