Lithotripsy
| Lithotripsy | |
|---|---|
| Specialty | {{#statements:P1995}} |
| ICD-9-CM | 98 |
| MeSH | D008096 |
| MedlinePlus | 007113 |
Lithotripsy is a medical procedure involving the physical destruction of hardened masses like kidney stones,[1]:{{{3}}} bezoars[2]:{{{3}}} or gallstones. The term is derived from the Greek words meaning "breaking (or pulverizing) stones" (litho- + τρίψω [tripso]).
Techniques
- Extracorporeal shock wave lithotripsy (ESWL)
- Intracorporeal (Endoscopic lithotripsy)
- Laser lithotripsy
- Electrohydraulic lithotripsy
- Mechanical lithotripsy
- Ultrasonic lithotripsy
History
Surgery was the only method to remove stones too large to pass until lithotripsy was developed and replaced it as the most frequent treatment beginning the 1980s. In ESWL, external shockwaves are focused at the stone to pulverize it. Ureteroscopic methods use a rigid or flexible scope to reach the stone and direct mechanical or light energy is applied. Endoscopy can use different energy sources: ultrasound, electrohydraulic, mechanical and lasers.
Extracorporal shock wave therapy (ESWL) was first used on kidney stones in 1980 and is applied to gallstones and pancreatic stones. External shockwaves are focused and pulverize the stone which is located by imaging. The first shockwave lithotriptor was the Dornier HM3, a device for testing aircraft parts. Second generation devices used piezoelectric or electromagnetic generators. American Urological Association guidelines consider ESWL a potential primary treatment for stones less than 2 cm.
Electrohydraulic lithotripsy is an industrial technique for fragmenting rocks by using electrodes to create shockwaves that 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.
Laser lithotripsy was introduced in the 1980s. Pulsed dye lasers emit 504 nm light that is delivered to the stone by optical fibers through a scope. Holmium lasers were developed more recently and produce smaller fragments
