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  • Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?

Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?

Get the facts

Your options

  • Wait for the stone to pass while using medicine to control the pain. Your doctor may also prescribe a medicine to help the stone pass, such as an alpha-blocker.
  • Use lithotripsy to break up the stone. The pieces of stone may pass sooner with less pain.

Key points to remember

  • The smaller a stone is, the more likely it is to pass on its own.
  • The type of treatment you need depends on how big the stone is and how likely it is to pass on its own. If the stone will probably pass and you can control your pain with medicine, home treatment may be enough.
  • If you can't control your pain with medicine, or if the stone is blocking the urine flow, your best choice may be lithotripsy. Lithotripsy may work best for kidney stones that are still in the kidney or in the part of the ureter close to the kidney.
  • You have options other than this procedure, but it is the most commonly used method because it works well and does not require surgery.
  • You will probably not have lithotripsy if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.
FAQs

What are kidney stones?

Kidney stones are pieces of minerals that form in the kidneys. They form when the normal balance of water, salts, minerals, and other substances found in your urine changes. The type of kidney stones you get depends on how this balance changes. Most kidney stones are calcium-type—they form when the calcium levels in your urine change.

Kidney stones may stay in the kidney or travel out of the body through the urinary tract.

When moving through the urinary tract, a stone may cause great pain and other symptoms. Kidney stones can cause long-term damage to the urinary tract if they keep growing or if they block the flow of urine from the kidneys.

What is lithotripsy?

Extracorporeal shock wave lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone. Stone fragments usually pass within a few weeks. Depending on the size of the stone, you may need only one treatment. The larger the stone, the more likely it is that you will need more than one treatment.

Lithotripsy is only one method used to break up kidney stones. But it is the most commonly used method, because it does not require surgery.

What are the risks of lithotripsy?

Risks of lithotripsy include:

  • Pain from passing stone fragments. This is the most common side effect.
  • Blocked urine flow if stone fragments get stuck in the urinary tract. The fragments may then need to be removed with a ureteroscope.
  • Urinary tract infection.
  • Bleeding around the outside of the kidney.

What are the risks of not using lithotripsy to treat kidney stones?

Unless the kidney stone is blocking urine flow or you have a urinary tract infection, the risks of not using lithotripsy or another method to break up the stone are small. But you may have pain longer.

Why might your doctor recommend lithotripsy?

Your doctor may recommend this procedure if:

  • The stone is not passing on its own and is causing pain that will not go away.
  • The stone is completely blocking the urine flow.
  • You have only one working kidney, and your doctor worries that the stone is affecting how well the kidney works.
  • The stone is causing serious bleeding.
  • The stone keeps growing.
  • You have had a kidney transplant, and your doctor worries about damage from a stone.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have lithotripsy Have lithotripsy
  • The doctor uses shock waves to break the kidney stone into small pieces that can pass from the body.
  • You may receive a sedative or local anesthesia. You will not need to stay in the hospital overnight.
  • If your stones are larger than 2.5 cm (1 inch), your doctor may put in a tube called a stent to keep the ureter open.
  • The stone will likely pass sooner than if you didn't have lithotripsy. Most pass in a few days.
  • Because it breaks stones into smaller pieces, you will likely have less pain when the stone passes.
  • The procedure has risks, such as:
    • Pain from passing stone fragments.
    • Blocked urine flow if stone fragments get stuck in the urinary tract.
    • Urinary tract infection.
    • Bleeding around the outside of the kidney.
  • If your stones are large, you may need more than one treatment.
  • If you are pregnant, the sound waves and X-rays may be harmful to the fetus.
  • It could cause problems if you have a bleeding disorder or if you take blood thinners (anticoagulants).
Don't have lithotripsy Don't have lithotripsy
  • You wait for the stone to pass on its own. This may take 1 to 4 weeks.
  • You take medicine to control the pain.
  • You drink enough fluids so that you don't get dehydrated.
  • You may take medicine to help the stone pass.
  • You avoid the risks of having a medical procedure.
  • This option is safest if you:
    • Are pregnant.
    • Have a bleeding disorder.
    • Have a urinary tract infection.
    • Have a kidney infection, kidney cancer, or certain other kidney problems.
  • If the stone is large, it may be more painful to pass and may block the urinary tract.
  • You may have more pain over a longer period of time than if you had used lithotripsy.
  • The stone may not pass on its own.
  • The stone could keep growing.
  • If you have had a kidney transplant, your kidney could be damaged by passing the stone.
  • If you have only one kidney, passing the stone could affect how well your kidney works.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treating kidney stones with extracorporeal shock wave lithotripsy (ESWL)

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had a kidney stone before. I remember the pain, and the medicine did not help me all that much. When I started to pass another stone, I knew right away that I wanted to try breaking up the stone. Hopefully the stone will pass more easily and cause less pain.

Roy, age 32

I have several friends who have had kidney stones. They told me how much it hurt. Now that I am passing a stone, I know what they mean. My doctor gave me a strong pain medicine, and we talked about having the stone broken up to make it pass easier. But I prefer to avoid any medical procedures if I can. My doctor says it should only take a few days to pass the stone, and as long as the pain medicine works, I'll get through it okay.

José, age 38

I went to the doctor because of the pain in my side. She did some tests and told me I have a kidney stone. She said it is pretty large, but it should pass on its own. But she also said that because of its size, it might take awhile to pass and the pain could be pretty intense. We decided to break up the stone using ESWL to try to reduce the time it takes to pass and the pain involved.

Marge, age 50

The doctor told me my pain is being caused by a kidney stone that I'm passing. He gave me some strong pain medicine and said I could have the stone broken up, which might make it pass more easily. He also told me the stone is pretty small and should pass soon. I'm going to try the pain medicine and make sure I drink enough water for now. If the pain gets to be too bad, I can change my mind and have the stone broken up.

Rita, age 28

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have lithotripsy for kidney stones

Reasons to wait for the stone to pass on its own

I want to increase the chance of my stone passing sooner.

I'm not concerned with how soon my stone passes.

More important
Equally important
More important

I'm worried about the pain from passing a kidney stone.

I can use medicine to control the pain.

More important
Equally important
More important

I'm not bothered by having a medical procedure.

I don't want to have a medical procedure.

More important
Equally important
More important

I know that the procedure has risks, but I'm not concerned about them.

I am concerned about the risks of the procedure.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having lithotripsy

Waiting for the stone to pass on its own

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Will most small stones pass on their own?

  • YesThat's right. The smaller a stone is, the more likely it is to pass on its own.
  • NoNo, that's not right. The smaller a stone is, the more likely it is to pass on its own.
  • I'm not sureIt may help to go back and read "Get the Facts." The smaller a stone is, the more likely it is to pass on its own.
2.

Is lithotripsy is a good choice for everyone?

  • YesNo, that's not right. You will probably not have lithotripsy if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.
  • NoYes, that's right. You will probably not have lithotripsy if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.
  • I'm not sureIt may help to go back and read "Get the Facts." Lithotripsy isn't the best choice if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.
3.

Are you likely to have less pain when the stone passes if you have lithotripsy?

  • YesYes, that's right. You'll likely have less pain, because lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone.
  • NoNo, that's wrong. You'll likely have less pain, because lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone.
  • I'm not sureIt may help to go back and read "Get the Facts." You'll likely have less pain, because lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Tushar J. Vachharajani, MD, FASN, FACP - Nephrology
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Wait for the stone to pass while using medicine to control the pain. Your doctor may also prescribe a medicine to help the stone pass, such as an alpha-blocker.
  • Use lithotripsy to break up the stone. The pieces of stone may pass sooner with less pain.

Key points to remember

  • The smaller a stone is, the more likely it is to pass on its own.
  • The type of treatment you need depends on how big the stone is and how likely it is to pass on its own. If the stone will probably pass and you can control your pain with medicine, home treatment may be enough.
  • If you can't control your pain with medicine, or if the stone is blocking the urine flow, your best choice may be lithotripsy. Lithotripsy may work best for kidney stones that are still in the kidney or in the part of the ureter close to the kidney.
  • You have options other than this procedure, but it is the most commonly used method because it works well and does not require surgery.
  • You will probably not have lithotripsy if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.
FAQs

What are kidney stones?

Kidney stones are pieces of minerals that form in the kidneys. They form when the normal balance of water, salts, minerals, and other substances found in your urine changes. The type of kidney stones you get depends on how this balance changes. Most kidney stones are calcium-type—they form when the calcium levels in your urine change.

Kidney stones may stay in the kidney or travel out of the body through the urinary tract .

When moving through the urinary tract, a stone may cause great pain and other symptoms. Kidney stones can cause long-term damage to the urinary tract if they keep growing or if they block the flow of urine from the kidneys.

What is lithotripsy?

Extracorporeal shock wave lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone. Stone fragments usually pass within a few weeks. Depending on the size of the stone, you may need only one treatment. The larger the stone, the more likely it is that you will need more than one treatment.

Lithotripsy is only one method used to break up kidney stones. But it is the most commonly used method, because it does not require surgery.

What are the risks of lithotripsy?

Risks of lithotripsy include:

  • Pain from passing stone fragments. This is the most common side effect.
  • Blocked urine flow if stone fragments get stuck in the urinary tract. The fragments may then need to be removed with a ureteroscope.
  • Urinary tract infection.
  • Bleeding around the outside of the kidney.

What are the risks of not using lithotripsy to treat kidney stones?

Unless the kidney stone is blocking urine flow or you have a urinary tract infection, the risks of not using lithotripsy or another method to break up the stone are small. But you may have pain longer.

Why might your doctor recommend lithotripsy?

Your doctor may recommend this procedure if:

  • The stone is not passing on its own and is causing pain that will not go away.
  • The stone is completely blocking the urine flow.
  • You have only one working kidney, and your doctor worries that the stone is affecting how well the kidney works.
  • The stone is causing serious bleeding.
  • The stone keeps growing.
  • You have had a kidney transplant, and your doctor worries about damage from a stone.

2. Compare your options

  Have lithotripsy Don't have lithotripsy
What is usually involved?
  • The doctor uses shock waves to break the kidney stone into small pieces that can pass from the body.
  • You may receive a sedative or local anesthesia. You will not need to stay in the hospital overnight.
  • If your stones are larger than 2.5 cm (1 inch), your doctor may put in a tube called a stent to keep the ureter open.
  • You wait for the stone to pass on its own. This may take 1 to 4 weeks.
  • You take medicine to control the pain.
  • You drink enough fluids so that you don't get dehydrated.
  • You may take medicine to help the stone pass.
What are the benefits?
  • The stone will likely pass sooner than if you didn't have lithotripsy. Most pass in a few days.
  • Because it breaks stones into smaller pieces, you will likely have less pain when the stone passes.
  • You avoid the risks of having a medical procedure.
  • This option is safest if you:
    • Are pregnant.
    • Have a bleeding disorder.
    • Have a urinary tract infection.
    • Have a kidney infection, kidney cancer, or certain other kidney problems.
What are the risks and side effects?
  • The procedure has risks, such as:
    • Pain from passing stone fragments.
    • Blocked urine flow if stone fragments get stuck in the urinary tract.
    • Urinary tract infection.
    • Bleeding around the outside of the kidney.
  • If your stones are large, you may need more than one treatment.
  • If you are pregnant, the sound waves and X-rays may be harmful to the fetus.
  • It could cause problems if you have a bleeding disorder or if you take blood thinners (anticoagulants).
  • If the stone is large, it may be more painful to pass and may block the urinary tract.
  • You may have more pain over a longer period of time than if you had used lithotripsy.
  • The stone may not pass on its own.
  • The stone could keep growing.
  • If you have had a kidney transplant, your kidney could be damaged by passing the stone.
  • If you have only one kidney, passing the stone could affect how well your kidney works.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treating kidney stones with extracorporeal shock wave lithotripsy (ESWL)

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had a kidney stone before. I remember the pain, and the medicine did not help me all that much. When I started to pass another stone, I knew right away that I wanted to try breaking up the stone. Hopefully the stone will pass more easily and cause less pain."

— Roy, age 32

"I have several friends who have had kidney stones. They told me how much it hurt. Now that I am passing a stone, I know what they mean. My doctor gave me a strong pain medicine, and we talked about having the stone broken up to make it pass easier. But I prefer to avoid any medical procedures if I can. My doctor says it should only take a few days to pass the stone, and as long as the pain medicine works, I'll get through it okay."

— José, age 38

"I went to the doctor because of the pain in my side. She did some tests and told me I have a kidney stone. She said it is pretty large, but it should pass on its own. But she also said that because of its size, it might take awhile to pass and the pain could be pretty intense. We decided to break up the stone using ESWL to try to reduce the time it takes to pass and the pain involved."

— Marge, age 50

"The doctor told me my pain is being caused by a kidney stone that I'm passing. He gave me some strong pain medicine and said I could have the stone broken up, which might make it pass more easily. He also told me the stone is pretty small and should pass soon. I'm going to try the pain medicine and make sure I drink enough water for now. If the pain gets to be too bad, I can change my mind and have the stone broken up."

— Rita, age 28

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have lithotripsy for kidney stones

Reasons to wait for the stone to pass on its own

I want to increase the chance of my stone passing sooner.

I'm not concerned with how soon my stone passes.

             
More important
Equally important
More important

I'm worried about the pain from passing a kidney stone.

I can use medicine to control the pain.

             
More important
Equally important
More important

I'm not bothered by having a medical procedure.

I don't want to have a medical procedure.

             
More important
Equally important
More important

I know that the procedure has risks, but I'm not concerned about them.

I am concerned about the risks of the procedure.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having lithotripsy

Waiting for the stone to pass on its own

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Will most small stones pass on their own?

  • Yes
  • No
  • I'm not sure
That's right. The smaller a stone is, the more likely it is to pass on its own.

2. Is lithotripsy is a good choice for everyone?

  • Yes
  • No
  • I'm not sure
Yes, that's right. You will probably not have lithotripsy if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or some other kidney problems.

3. Are you likely to have less pain when the stone passes if you have lithotripsy?

  • Yes
  • No
  • I'm not sure
Yes, that's right. You'll likely have less pain, because lithotripsy uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Tushar J. Vachharajani, MD, FASN, FACP - Nephrology

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