Lithotripsy
| Lithotripsy | |
|---|---|
| ICD-9-CM | 98 |
| MeSH | D008096 |
| MedlinePlus | 007113 |
Lithotripsy is a procedure involving the physical destruction of hardened masses like kidney stones,[1] bezoars[2] or gallstones, which may be done non-invasively. The term is derived from the Greek words meaning "breaking (or pulverizing) stones" (litho- + τρίψω [tripso]).
Uses
Lithotripsy is a non-invasive procedure used to break up hardened masses like kidney stones,[1] bezoars[2] or gallstones.
Contraindications
Commonly cited absolute contraindications to shock wave lithotripsy (SWL) include pregnancy, coagulopathy or use of platelet aggregation inhibitors, aortic aneurysms, severe untreated hypertension, and untreated urinary tract infections.[1]
Techniques
- Extracorporeal shock wave therapy (lithotripsy)[3]
- Intracorporeal (endoscopic lithotripsy):
- Laser lithotripsy : effective for larger stones (>2 cm) with good stone-free and complication rates.[4]
- Electro hydraulic lithotripsy
- Mechanical lithotripsy
- Ultrasonic lithotripsy : safer for small stones (<10 mm)
History
Surgery was the only method to remove stones too large to pass until French surgeon and urologist Jean Civiale in 1832 invented a surgical instrument (the lithotrite) to crush stones inside the urinary bladder without having to open the abdomen. To remove a calculus, Civiale inserted his instrument through the urethra and bored holes in the stone. Afterwards, he crushed it with the same instrument and aspirated the resulting fragments or let them flow normally with urine.[citation needed]
Lithotripsy replaced using lithotrites as the most common treatment beginning in the mid 1980s. In extracorporeal shock wave lithotripsy (ESWL), external shockwaves are focused at the stone to pulverize it.[5] Ureteroscopic methods use a rigid or flexible scope to reach the stone and direct mechanical or light energy at it. Endoscopy can use lasers as well as other modes of energy delivery: ultrasound or electrohydraulics.[citation needed]
ESWL was first used on kidney stones in 1980. It is also applied to gallstones and pancreatic stones. External shockwaves are focused and pulverize the stone which is located by imaging. The first shockwave lithotriptor approved for human use was the Dornier HM3 (human model 3) derived from a device used for testing aerospace parts. Second generation devices used piezoelectricity or electromagnetism generators. American Urological Association guidelines consider ESWL a potential primary treatment for stones between 4 mm and 2 cm.[5]
Electrohydraulic lithotripsy is an industrial technique for fragmenting rocks by using electrodes to create shockwaves. It was applied to bile duct stones in 1975. It can damage tissue and is mostly used in biliary tract specialty centers. Pneumatic mechanical devices have been used with endoscopes, commonly for large and hard stones.[6]
Laser lithotripsy was introduced in the 1980s. Pulsed dye lasers emit 504 nm (cyan-colored) light that is delivered to the stone by optical fibers through a scope. Holmium:YAG lasers were developed more recently and produce smaller fragments.
References
- ^ a b "Lithotripsy". A.D.A.M. Medical Encyclopedia. Medline Plus. Bethesda, MD, U.S.A.: United States National Library of Medicine. September 16, 2011. OCLC 244795383. Archived from the original on July 27, 2011. Retrieved October 28, 2012.
Lithotripsy is a medical procedure that uses shock waves to break up stones in the kidney, bladder, or ureter (tube that carries urine from your kidneys to your bladder).
- ^ a b Hayashi K, Ohara H, Naitoh I, Okumura F, Andoh T, Itoh T, et al. (December 2008). "Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report". Cases Journal. 1 (1): 385. doi:10.1186/1757-1626-1-385. PMC 2627813. PMID 19077219.
There have been reports on the methods for treating bezoars, including surgical treatment, endoscopic lithotripsy, electrohydraulic lithotripsy, laser therapy, and even the use of extracorporeal shock wave lithotripsy (ESWL).
- ^ Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P (August 2023). "Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones". The Cochrane Database of Systematic Reviews. 2023 (8): CD007044. doi:10.1002/14651858.CD007044.pub4. PMC 10392035. PMID 37526261.
{{cite journal}}: CS1 maint: PMC embargo expired (link) - ^ Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK (October 2012). "Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis". Journal of Endourology. 26 (10): 1257–1263. doi:10.1089/end.2012.0217. PMID 22642568.
- ^ a b "Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones". WebMD. Retrieved 2017-01-14.
- ^ Rebuck DA, Macejko A, Bhalani V, Ramos P, Nadler RB (March 2011). "The natural history of renal stone fragments following ureteroscopy". Urology. 77 (3): 564–568. doi:10.1016/j.urology.2010.06.056. PMID 21109293.