Laser Lithotripsy

Definition

Laser lithotripsy is a procedure to break apart kidney stones in the urinary tract. It is done with a ureteroscope passed into the tubes of the urinary tract. Incisions are not needed.

The laser breaks the kidney stones into smaller pieces that can either be removed by the surgeon or pass out of the body in the urine.

Kidney Stones

Kidney Stones
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Reasons for Procedure    TOP

Kidney stones can become trapped anywhere in the urinary tract, including the kidney and the ureter. The ureter is a tube that carries urine from the kidneys to the bladder. If a stone gets stuck in the ureter it can cause a blockage and back up of urine into the kidney. They can also be quite painful.

Laser lithotripsy is used to break apart the kidney stone so that it can pass through the ureter. The pieces will either be removed by the surgeon using a special basket or left in place where they will move from the ureter to the bladder, then out of the body with the urine.

Laser lithotripsy may be chosen if other non-surgical treatments have failed or if kidney stones are:

  • Too large to pass
  • Irregular in shape
  • Causing bleeding or damage to surrounding tissue

Possible Complications    TOP

Complications are rare, but all procedures have some potential risk. Your doctor will review potential problems, like:

  • Increasing or large amounts of blood in the urine
  • Injury to the urinary tract
  • A temporary stent (placed to keep the ureter open) may move out of position
  • Infection
  • Need for additional procedures to remove stone fragments that do not pass

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect    TOP

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Blood and urine tests
  • Imaging tests to help locate the stones
  • Chest X-ray
  • Electrocardiogram (EKG) to evaluate electrical activity of the heart
  • Analysis to determine size and type of the stones

You may need to:

  • Arrange for a ride home after the procedure.
  • Arrange for help at home during recovery.
  • Stop certain medications up to a week before the procedure.
  • Avoid eating or drinking after midnight prior to the procedure.

Talk to your doctor about any allergies you may have, or what medications or supplements you currently take and may need to stop.

Anesthesia

General anesthesia will be used. You will be asleep through the procedure.

Description of Procedure    TOP

A ureteroscope is an instrument with a long thin tube that looks like a straw. The doctor can use this scope to view the urinary tract, find kidney stones, and pass instruments to the stone.

The scope enters the urinary tract through the urethra, the tube that carries urine out of the body. The scope continues to pass through the urethra, to the bladder, into the ureter and then to the stone.

Once the doctor sees the stone, a fiber will be sent through the scope to the stone. The fiber can create a laser beam to break up the stone. Small pieces may be removed using a basket that is passed through the scope. Small grain-like pieces may remain and will be gradually passed through the urine.

A temporary stent may be placed in the ureter. The stent will keep the ureter open, improve urine flow, and help the stone pieces pass. The stent will be removed after a few weeks.

How Long Will It Take?    TOP

Up to 1 hour

How Much Will It Hurt?    TOP

Anesthesia will prevent pain during surgery. The ureter bladder can spasm and cause pain after the surgery. There may also be some pain or discomfort in the back. Stents can also cause discomfort in some. Pain and discomfort after the procedure can be managed with medications.

Post-procedure Care    TOP

At the Care Center

The medical team will monitor your recovery including your blood pressure, pulse, and breathing. Recovery may also include:

  • Pain medications
  • Antibiotics to decrease the risk of the infection
  • X-rays to look for remaining stone fragments or confirm the stent placement

Healthcare providers will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks

There are also steps you can take to reduce your chances of infection, such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks

At Home

Full recovery can take 1-2 weeks. Fatigue and discomfort is common but will fade during recovery. It may require minor changes to your daily routine.

Call Your Doctor    TOP

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Inability to urinate
  • Pain that cannot be controlled with the medications you’ve been given
  • Redness, warmth, excessive bleeding, or drainage
  • Signs of infection, including fever or chills
  • Persistent nausea or vomiting
  • Increasing or large amounts of blood in the urine
  • New or worsening symptoms

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Kidney Foundation
https://www.kidney.org
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org
The Kidney Foundation of Canada
http://www.kidney.ca

References:

Kidney stones in adults. National Kidney and Urologic Diseases Information Clearinghouse website. Available at:
...(Click grey area to select URL)
Updated February 2013. Accessed March 7, 2016.
Nephrolithiasis. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated February 24, 2016. Accessed March 7, 2016.
Surgery for kidney stones. Washington University School of Medicine in St. Louis website. Available at:
...(Click grey area to select URL)
Accessed March 7, 2016.
Ureteroscopy. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones_Ureteroscopy. Accessed March 7, 2016.
Ureteroscopy and laser lithotripsy. University of Florida Department of Urology website. Available at:
...(Click grey area to select URL)
Accessed March 7, 2016.
Last reviewed March 2016 by Adrienne Carmack, MD
Last Updated: 3/7/2016

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