Laser Lithotripsy

Laser lithotripsy is a minimally invasive medical procedure that uses a focused laser beam to break kidney stones, ureteral stones, or bladder stones into smaller pieces. These smaller fragments can then pass more easily out of the body through urine or be removed by a surgeon. It is a common and effective treatment for stones that are too large to pass on their own or cause significant symptoms.

What is Laser Lithotripsy?

Laser lithotripsy is a procedure that uses a laser to break up stones found in the urinary tract, such as kidney stones, ureteral stones (stones in the tube connecting the kidney to the bladder), or bladder stones. A thin, flexible tube with a camera (ureteroscope) is inserted into the urinary tract to locate the stone, and then a laser fiber delivers energy to fragment it.

This procedure is a type of endoscopic surgery, meaning it uses a scope inserted through a natural body opening rather than making an incision. The surgeon guides the ureteroscope through the urethra, bladder, and into the ureter or kidney to reach the stone. Once the stone is located, a tiny laser fiber is passed through the scope. The laser emits pulses of energy that shatter the stone into very small pieces, sometimes as fine as sand. These fragments are either small enough to pass naturally in your urine or are removed by the surgeon using a small basket-like device passed through the ureteroscope. This method is highly effective for various stone types and sizes, offering a precise way to target and break up stones. (MedlinePlus, Mayo Clinic)

Why it's done

Laser lithotripsy is performed to treat urinary tract stones that are causing symptoms or are too large to pass on their own. These stones can cause severe pain, block urine flow, or lead to infections. By breaking the stones into smaller pieces, the procedure helps relieve symptoms, prevent complications, and allow the body to clear the stone fragments.

You might need laser lithotripsy if you have kidney stones or other urinary tract stones that are causing significant pain, blood in your urine, recurrent urinary tract infections, or a blockage in your urinary tract. Stones that are larger than about 5-6 millimeters (about 0.2 inches) often do not pass on their own and may require intervention. (Mayo Clinic) This procedure is often chosen when other treatments, such as watchful waiting or medication to help stones pass, are not suitable or have failed. It is particularly effective for stones located in the ureter or lower kidney, and for stones that are hard or resistant to other forms of lithotripsy, such as shock wave lithotripsy. Your doctor will recommend the best treatment based on the stone's size, location, and composition. (MedlinePlus)

How to prepare

Preparing for laser lithotripsy typically involves discussing your medical history and medications with your doctor, especially blood thinners, which you may need to stop taking temporarily. You will also be instructed not to eat or drink for several hours before the procedure and to arrange for someone to drive you home afterward, as you will receive anesthesia.

Before your procedure, your doctor will review your current medications. It is crucial to inform them about all prescription drugs, over-the-counter medicines, supplements, and herbal remedies you are taking. You may be asked to stop taking blood-thinning medications, such as aspirin, ibuprofen, or warfarin, for a specified period before surgery to reduce the risk of bleeding. (Mayo Clinic) You will receive specific instructions regarding food and drink restrictions. Typically, you will need to fast, meaning no food or drink, for at least 6-8 hours before the procedure. This is important to prevent complications related to anesthesia. You should also arrange for a responsible adult to drive you home after the procedure, as the effects of anesthesia can impair your judgment and coordination. Your doctor may also order blood tests or urine tests to check for infection or assess your overall health. (MedlinePlus)

What happens during

During laser lithotripsy, you will receive anesthesia, usually general anesthesia, so you will be asleep and feel no pain. A surgeon then inserts a thin, flexible tube (ureteroscope) through your urethra and bladder to reach the stone. A laser fiber is passed through the scope to break the stone into smaller pieces, which are then removed or allowed to pass.

Once you are under anesthesia, the surgeon will carefully insert the ureteroscope into your urethra, the tube that carries urine out of your body. The scope is gently advanced through your bladder and into the ureter, the tube connecting your kidney to your bladder, until the stone is located. The ureteroscope has a small camera that allows the surgeon to see the stone on a monitor. (Mayo Clinic) A tiny laser fiber is then threaded through the ureteroscope to the stone. The laser emits pulses of energy that break the stone into fragments. The surgeon may use a small basket-like instrument to remove these fragments. In some cases, a temporary tube called a ureteral stent may be placed in the ureter to help urine drain and prevent swelling. This stent is usually removed a few days to a few weeks later in a separate, simpler procedure. The entire procedure typically takes 30 minutes to 2 hours, depending on the stone's size and location. (MedlinePlus)

Recovery & timeline

After laser lithotripsy, you will spend some time in a recovery area while the anesthesia wears off, usually being discharged the same day. You may experience some discomfort, blood in your urine, and frequent urination for a few days. Most people can return to light activities within 24-48 hours and resume normal activities within a week, though full recovery can vary.

Immediately after the procedure, you will be monitored in a recovery room. You might feel some mild to moderate pain or discomfort in your back or side, which can be managed with prescribed or over-the-counter pain relievers. It is common to see blood in your urine for several days, and you may experience a burning sensation during urination or a frequent urge to urinate. (Mayo Clinic) If a ureteral stent was placed, you might feel more discomfort, including flank pain, bladder spasms, and increased urgency to urinate. This is normal and usually resolves once the stent is removed. Your doctor will provide instructions on when to remove the stent, which is typically done in an outpatient setting. It is important to drink plenty of fluids to help flush out any remaining stone fragments and prevent infection. Most people can return to work or light daily activities within a day or two, but strenuous exercise should be avoided for about a week. (MedlinePlus)

Risks & side effects

While laser lithotripsy is generally safe, potential risks include urinary tract infection, bleeding, pain, and discomfort. More serious, but rare, complications can include injury to the ureter or bladder, or a severe infection (sepsis). Your medical team will take precautions to minimize these risks and monitor you closely during and after the procedure.

Common side effects after laser lithotripsy include blood in the urine, discomfort or pain in the back or side, and a frequent urge to urinate. These symptoms are usually temporary and resolve within a few days. Urinary tract infections (UTIs) are also a possible complication, and you may be prescribed antibiotics to prevent or treat them. (MedlinePlus) Serious complications are rare but can include damage to the ureter, such as a tear or perforation, which might require additional procedures to repair. There is also a small risk of severe infection (sepsis), which requires immediate medical attention. In some cases, stone fragments may not pass completely, or new stones may form, requiring further treatment. Your doctor will discuss all potential risks and benefits with you before the procedure. (Mayo Clinic)

Success rate

Laser lithotripsy has a high success rate for clearing urinary tract stones, with studies showing that about 80% to 90% of stones are successfully fragmented and cleared after one procedure. The success rate can vary based on factors like the stone's size, location, and composition, with smaller stones generally having a higher clearance rate.

The effectiveness of laser lithotripsy is well-established, particularly for stones in the ureter and kidney. For ureteral stones, the stone-free rate (meaning no detectable stone fragments remaining) is often reported to be between 80% and 90% after a single treatment. For kidney stones, the success rate can be slightly lower, especially for larger or more complex stones, but still remains high. (Cochrane Library) Factors that can influence the success rate include the size and hardness of the stone, its location within the urinary tract, and the patient's anatomy. While most stones are successfully treated in one session, some people may require a second procedure to achieve complete stone clearance, especially if the initial stone was very large or multiple stones were present. Your doctor will discuss the expected success rate for your specific situation. (Mayo Clinic)

Frequently asked questions

Is laser lithotripsy painful?

During the procedure, you will be under anesthesia, so you will not feel any pain. Afterward, it is common to experience mild to moderate pain or discomfort in your back or side, along with a burning sensation during urination. This pain can usually be managed with prescribed or over-the-counter pain relievers and typically subsides within a few days. (Mayo Clinic)

How long does the laser lithotripsy procedure take?

The actual laser lithotripsy procedure typically takes between 30 minutes to 2 hours. The exact duration depends on several factors, including the size, number, and location of the stones, as well as any anatomical considerations. You will also spend additional time in preparation and recovery. (MedlinePlus)

Can all kidney stones be treated with laser lithotripsy?

Laser lithotripsy is highly effective for many types and sizes of kidney stones, especially those in the ureter or lower kidney. However, not all stones are treated with this method. Your doctor will consider the stone's size, location, composition, and your overall health to determine if laser lithotripsy is the most appropriate treatment for your specific situation. (Mayo Clinic)

What is a ureteral stent and why is it used after laser lithotripsy?

A ureteral stent is a thin, hollow tube that may be temporarily placed in your ureter after laser lithotripsy. It helps keep the ureter open, allowing urine to drain from the kidney to the bladder and facilitating the passage of any remaining stone fragments. It also helps reduce swelling that can occur after the procedure. The stent is typically removed a few days to a few weeks later. (MedlinePlus)

When can I return to work and normal activities after laser lithotripsy?

Most people can return to light activities, including work, within 24 to 48 hours after laser lithotripsy, provided they feel well and are no longer significantly affected by anesthesia. Strenuous activities, heavy lifting, and vigorous exercise should generally be avoided for about a week to allow for proper healing and to prevent complications. (Mayo Clinic)

What should I do if I have severe pain or fever after the procedure?

While some discomfort is normal, you should contact your doctor immediately if you experience severe, worsening pain that is not relieved by medication, a high fever (over 101°F or 38.3°C), chills, persistent nausea or vomiting, or significant difficulty urinating. These could be signs of a complication, such as an infection, that requires prompt medical attention. (MedlinePlus)

Sources

• MedlinePlus — Laser Lithotripsy
• Mayo Clinic — Laser Lithotripsy
• Cochrane Library — Laser Lithotripsy