{{Short description|Medical procedure for breaking up hardened masses}} {{Infobox medical intervention |Name=Lithotripsy |Image= |Caption= |ICD10= |ICD9={{ICD9proc|98}} |MedlinePlus=007113 |MeshID=D008096 |OPS301= |OtherCodes= |HCPCSlevel2=}} '''Lithotripsy''' is a procedure involving the physical destruction of hardened masses like kidney stones,{{R|"MedlinePlus1"}} bezoars{{R|"Hayashi1"}}, gallstones or sialolithiasis,<ref>Königsberger R, Feyh J, Goetz A, Kastenbauer E. Endoscopically-controlled electrohydraulic intracorporeal shock wave lithotripsy (EISL) of salivary stones. J Otolaryngol. 1993 Feb;22(1):12-3</ref> which may be done non-invasively. The term is derived from Greek words meaning "breaking (or pulverizing) stones" (litho- + τρίψω [tripso]).
== Applications == Lithotripsy is used to break up hardened masses like kidney stones,{{R|"MedlinePlus1"}} bezoars{{R|"Hayashi1"}} 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.<ref>{{cite journal |last1=Reynolds |first1=Luke F. |last2=Kroczak |first2=Tad |last3=Pace |first3=Kenneth T. |title=Indications and contraindications for shock wave lithotripsy and how to improve outcomes |journal=Asian Journal of Urology |date=October 2018 |volume=5 |issue=4 |pages=256–263 |doi=10.1016/j.ajur.2018.08.006 |pmid=30364729 |pmc=6197584 }}</ref>
==Techniques== Some lithotripsy techniques are non-invasive procedures. * Extracorporeal shock wave therapy (lithotripsy)<ref>{{cite journal |vauthors = Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P |title = Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones |journal = The Cochrane Database of Systematic Reviews |volume = 2023 |issue = 8 |article-number = CD007044 |date = August 2023 |pmid = 37526261 |pmc = 10392035 |doi = 10.1002/14651858.CD007044.pub4 }}</ref> * Intracorporeal (endoscopic lithotripsy): ** Laser lithotripsy: Established treatment for ureteral and renal stones of various sizes, including small, medium, and large calculi, with good stone-free and complication rates.<ref>{{Cite web |title=EAU Guidelines on Urolithiasis - GUIDELINES - Uroweb |url=https://uroweb.org/guidelines/urolithiasis/chapter/guidelines?utm_source=chatgpt.com |access-date=2026-05-11 |website=uroweb.org |language=en}}</ref> ** Electrohydraulic 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|date=January 2022}}
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.<ref name="webmd">{{Cite news|url=http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones|title=Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones|newspaper=WebMD |access-date=2017-01-14}}</ref> 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|date=January 2022}}
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.<ref name="webmd" />
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.<ref name="RebuckMacejko2011">{{cite journal | vauthors = Rebuck DA, Macejko A, Bhalani V, Ramos P, Nadler RB | title = The natural history of renal stone fragments following ureteroscopy | journal = Urology | volume = 77 | issue = 3 | pages = 564–568 | date = March 2011 | pmid = 21109293 | doi = 10.1016/j.urology.2010.06.056 }}</ref> Pneumatic lithotripsy has also been successfully applied in the treatment of salivary stones during sialendoscopy, offering a minimally invasive alternative for large or impacted calculi while preserving the salivary duct anatomy.<ref name="Sengor2022">{{cite journal | vauthors = Şengör GA, Bilgili AM | title = A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy | journal = Ann Otol Rhinol Laryngol | volume = 131 | issue = 3 | pages = 268–276 | date = March 2022 | doi = 10.1177/00034894211018926 | pmid = 34049458 | url = https://www.researchgate.net/publication/351959659_A_Novel_Approach_for_the_Treatment_of_Sialolithiasis_that_Preserves_Salivary_Duct_Anatomy#fullTextFileContent | access-date = 31 July 2025 }}</ref>
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 then developed and produce smaller fragments and have long been considered the standard technology for endoscopic lithotripsy according to major urological guidelines such as those of the American Urological Association and the European Association of Urology.<ref>{{Cite web |title=Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2025) - American Urological Association |url=https://www.auanet.org/guidelines-and-quality/guidelines/surgical-management-of-kidney-and-ureteral-stones |access-date=2026-05-11 |website=www.auanet.org |language=en}}</ref><ref>{{Cite web |title=EAU Guidelines on Urolithiasis - GUIDELINES - Uroweb |url=https://uroweb.org/guidelines/urolithiasis/chapter/guidelines? |access-date=2026-05-11 |website=uroweb.org |language=en}}</ref> More recently, thulium fibre lasers (TFL) have been introduced for ureteroscopic lithotripsy and offer several advantages over Holmium:YAG lasers, including higher stone‑free rates, shorter operative times, and reduced stone retropulsion.<ref>{{Cite journal |last=Ulvik |first=Øyvind |last2=Æsøy |first2=Mathias Sørstrand |last3=Juliebø-Jones |first3=Patrick |last4=Gjengstø |first4=Peder |last5=Beisland |first5=Christian |date=July 2022 |title=Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial |url=https://pubmed.ncbi.nlm.nih.gov/35300888 |journal=European Urology |volume=82 |issue=1 |pages=73–79 |doi=10.1016/j.eururo.2022.02.027 |issn=1873-7560 |pmid=35300888|hdl=11250/3010970 |hdl-access=free }}</ref><ref>{{Cite journal |last=Samira |first=Nidal |last2=Sanee |first2=Moh |last3=Asali |first3=Murad |date=April 2026 |title=Thulium Fiber Laser Versus Holmium:YAG for Urological Stone Lithotripsy: A Systematic Review and Meta-Analysis |url=https://pubmed.ncbi.nlm.nih.gov/41657353 |journal=Photobiomodulation, Photomedicine, and Laser Surgery |volume=44 |issue=4 |pages=211–215 |doi=10.1177/25785478261415810 |issn=2578-5478 |pmid=41657353}}</ref> Several clinical studies and meta-analyses have demonstrated these benefits, suggesting that TFL may increasingly replace Ho:YAG as the preferred laser for endoscopic stone treatment.<ref>{{Cite journal |last=Ulvik |first=Øyvind |last2=Æsøy |first2=Mathias Sørstrand |last3=Juliebø-Jones |first3=Patrick |last4=Gjengstø |first4=Peder |last5=Beisland |first5=Christian |date=July 2022 |title=Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial |url=https://pubmed.ncbi.nlm.nih.gov/35300888 |journal=European Urology |volume=82 |issue=1 |pages=73–79 |doi=10.1016/j.eururo.2022.02.027 |issn=1873-7560 |pmid=35300888|hdl=11250/3010970 |hdl-access=free }}</ref>
Endovascular lithotripsy is an angioplasty procedure using a balloon internally fitted with an ultrasound generator.<ref>Brinton TJ, Ali ZA, Hill JM et al. [https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036531 ''Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses''], Circulation, 2019;139:834-836</ref> It can be used in the reduction of very calcified coronary arteries, with or without the combined usage of stents.<ref>Hill JM, Kereiakes DJ, Shlofmitz RA et al. [https://www.sciencedirect.com/science/article/pii/S0735109720373988 ''Intravascular lithotripsy for treatment of severely calcified coronary artery disease''], J Am Coll Cardiol, 2020;76: 2635-2646</ref>
== See also ==
== References == {{Reflist|refs=
<ref name="MedlinePlus1">{{MedlinePlusEncyclopedia|007113|Lithotripsy}}</ref>
<ref name="Hayashi1">{{cite journal | vauthors = Hayashi K, Ohara H, Naitoh I, Okumura F, Andoh T, Itoh T, Nakazawa T, Joh T | display-authors = 6 | title = Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report | journal = Cases Journal | volume = 1 | issue = 1 | page = 385 | date = December 2008 | pmid = 19077219 | pmc = 2627813 | doi = 10.1186/1757-1626-1-385 | quote = 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). | doi-access = free }}</ref> }}
{{Urologic procedures}} {{Digestive system procedures}}
Category:Digestive system procedures Category:Urologic procedures