What Is A Stone Crushing And When Should It Be?

Doctors use a stone crush very often. It is one of the therapeutic options for kidney stones. These are hard deposits of minerals and salts that form in the kidneys.

The problem is that when these stones move through the urinary tract and expand it, they cause a lot of pain. They are also associated with urinary tract obstruction. A kidney stone crush is intended to fragment these stones.

The idea is that the patient can then expel them more easily. There are several ways to perform the technique and certain important aspects should be considered before using them. In this article we therefore explain everything you need to know.

How does a kidney stone crush work?

A stone crush, as we mentioned in the introduction, is a medical procedure used to treat kidney stones. As an article from the Serrate & Ribal Urology Institute explains (English link), the English word comes from Greek and Latin. Lithos means ‘stone’ and terere means ‘to crush’.

Kidney stones are a high prevalence condition in the general population. For this reason, a stone crushing has become a very useful and widely used technique. It consists in fragmenting the stones in the kidney or in the urinary tract to make it easier to expel them with urine.

For this purpose, shock waves or a laser are used extracorporeally and non-invasively. The device used in shock waves is called a kidney stone pulverizer. The procedure is painless and requires no manipulation of the patient.

So much so that it is usually performed on an outpatient basis and without anesthesia. Other additional tests, such as ultrasound and X-rays, are used to determine the exact position of the stones.

Types of Kidney Stone Crushing

There are different modalities of renal stone crushing. The two main types of renal stone crushing are Extracorporeal Shock Wave (ESWL) and Laser Lithotripsy (FURSL).

Both techniques help fragment stones within the renal pathway. However, it is important to be familiar with the techniques to know which is more indicated depending on the patient’s health condition. The number and type of stones present also have an influence.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (Spanish link), as the name implies, uses shock waves to break the stones. The machine is a kidney stone crusher. It is responsible for directing waves to the point where the stones are located.

The advantage is that these waves only affect the stones. In other words, they do not damage the skin, muscles or other tissues. The procedure takes about an hour to perform.

Laser lithotripsy

Laser lithotripsy involves inserting a small flexible tube called an endoscope through the urinary tract. The endoscope has a camera on the end that allows the doctors to see the inside of the ducts.

When they find the stone, they use a laser directly on the stone to break it into fragments. This technique is shorter than extracorporeal shock wave lithotripsy and takes half an hour.

However, the fact that the instruments have to be inserted can cause more discomfort to the patient. As with the previous procedure, the patient can go home the day of the procedure.

How effective is the crushing of kidney stones?

Kidney stone crushing is a widely used technique, as it is considered safe and effective. According to a study published in the Oman Medical Journal, the success rate of ureteral cases is about 88%. With kidney stones, the percentage is somewhat lower, but also very high (74%).

Humans also have very few complications, such as urinary tract infections. Another National Kidney Foundation article states that 70-90% of people undergoing lithotripsy are stone-free in the months that follow.

However, it is possible that in some cases the fragments are still too large to pass. Under these circumstances, the doctor may need to repeat the procedure if necessary.

Preparation for the procedure

Before performing a lithotripsy, doctors need to know the patient’s history, treatments, and background. They usually also perform a series of additional tests. The idea is to try to locate the stones and know their dimensions before they become fragmented.

For this purpose, doctors can perform an intravenous pyelogram. This is a test similar to an X-ray in which doctors use a dye to locate the stones. They may also prescribe ultrasounds.

In the days before lithotripsy, the patient may need to stop taking certain medications. Particularly with anticoagulants, as they increase the risk of bleeding when the stones are expelled.

General anesthesia is not always necessary. In fact, there are many occasions when doctors perform this procedure on an outpatient basis under local or regional anesthesia. However, a number of patients remain in the hospital to monitor the possibility of complications.

How does the procedure work?

The two types of lithotripsy are similar but have important differences. In both, the patient usually lies, with or without anaesthetic. The procedure itself is not painful, but removing the fragments is.

Some fragments can cause a blockage in the urinary tract. In these cases, it is necessary to perform an endoscopy through the ureter to remove it. In addition, it is worth noting that, although less frequently, bleeding, fever or even infection can occur.

The major difference to keep in mind is that shock wave lithotripsy requires an endoscope to be inserted through the patient’s urinary tract. This can be more inconvenient and unpleasant.

Recovery after a kidney stone crush

After the procedure, the patient usually needs to rest in the hospital for at least an hour. This time can be extended if anesthesia has been used. It is necessary to check that the person is stable and that there are no complications.

If doctors have used shock wave lithotripsy in the following days, then the patient can go back to work. When performed with a laser, recovery is slower. This is because the endoscope procedure is invasive.

As mentioned above, pain or blood in the urine is likely to occur after the procedure. Hematomas in the skin, in the area where the shock waves had an impact, are also common. It is therefore advisable to rest, take painkillers and consult with any problems or warning signs.

Lifestyle and Prevention

The truth is that kidney stones can be caused by multiple factors. Certain factors influence its appearance. The incidence of kidney stones is very high.

One of the habits that can help reduce its appearance is to drink more fluids. In addition, people who often suffer from it should try to change their nutritional characteristics.

For example, doctors advise eating less animal protein and limiting sodium. In any case, it is up to the doctor to make a recommendation based on each patient and the causes of the stones.