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Shockwave lithotripsy: Tulane has had the Dornier HM-3 lithotripter since December of 1985. This device uniquely breaks up kidney stones without any incision. The word lithotripsy comes from the Greek, meaning “stone crushing.” Controlled shockwaves are utilized from outside the body to fragment kidney stones into smaller particles so that they pass spontaneously from the body. History: How does lithotripsy work? The second generation lithotripters do not use the “bathtub technology” and have actually increased the indications for lithotripsy. Shockwave generation: Localization of the stone: Stones can be visualized preferably using x-ray (fluoroscopy). This live tracking of the stone helps improve the efficacy of managing kidney stones. Computers are interfaced to analyze the images and to pinpoint the localization as well as progression of the fragmentation process. Whether the patient is under anesthesia in the water bath or on the second generation bathless tabletop model, the patient has a brief anesthetic experience while the stone is being fragmented. Monitoring patients: The patient’s electrocardiogram (EKG) and other monitoring equipment is used to give feedback to the computer as it releases the shockwaves. Stone fragmentation: Each shockwave that is delivered will break the stone into smaller particles until they are small enough to pass from the body. The imaging system, usually fluoroscopy, contantly monitors the fragmentation process and the urologist will determine the endpoint of a given treatment. Time duration: Typically, each procedure lasts from 45 to 90 minutes depending on the size, location, composition and density of a given stone. When does a patient require cystoscopy and ureteral stent placement? The variable factors that influence success following shockwave lithtripsy are: Size of the stone. The larger the stone, the more shockwaves are required or the number of sessions may be greater than one. Location. There are some locations in the kidney where the stone may remain impacted or gravity dependent collection of the fragments may occur. This may require additional treatment(s). Composition. The denser the stone, the harder the consistency and this can increase the number of treatments. History of previous stones. Chemical analyses of previously retrieved stone particles can give the urologist a better idea of the composition and thus could predict the outcome of the shockwave lithotripsy procedure. Based on these factors, your experienced urologist at Tulane Urology will be able to advise you on the need for a ureteral stent. This ureteral stent will help to passively dilate the ureter and thus promote passage of your stone particles. This stent is especially indicated if you have a large stone because of the possibility of obstruction of the kidney as you are passing the stone fragments. There is minimal discomfort assocated with the stent and your urologist will remove the stent as soon as it is safe to do so. If multiple treatments are pre-planned, based on the factors described above, a stent is highly recommended. What happens after treatment? Following your treatment, whether it is lithotripsy only or cystoscopy with stent placement and lithotripsy you will be taken to the recovery room for post-anesthesia recovery and once stable you will be discharged to go home the same day. As a general rule, patients recover within three days or less and may usually return to normal activities within that timeframe. If there are any concerns such as unusual bleeding or fever following lithotripsy, you need to contact your physician right away. Why choose Tulane Urology for my lithotripsy? Your urologist at Tulane has among the largest experience, not only regionally, but also nationally, in providing consultation and treatment for management of kidney stones using lithotripsy and other technologies. Advantages of lithotripsy: Less trauma to the patient. Since lithotripsy eliminates the need for open surgery, it clearly offers benefits which include less pain, quicker recovery and quicker return to normal activities therefore less disruption in the patient’s life. More convenience. Since this is an outpatient procedure, patients return home soon after the procedure is completed. Effectiveness and Safety. The lithotripter has an unbelievable safety track record and the huge amount of publication in the world literature attests to this safety record.
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