Internal Lithotripsy: Procedure Duration and Risks Explained - Urology

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Internal lithotripsy, also known as ureteroscopy with laser lithotripsy, is a procedure used to treat kidney stones that are too large to pass on their own or have not responded to extracorporeal shock wave lithotripsy (ESWL). This procedure involves the use of a small scope that is inserted into the urinary tract to locate and break up the stones using laser energy.


Procedure Duration
The duration of an internal lithotripsy procedure can vary depending on several factors, including the size and location of the stone, the complexity of the case, and the surgeon's experience. Generally, the procedure can take anywhere from 30 minutes to 2 hours. If the stone is located near the third lumbar vertebra (L3) and is encased in tissue, the procedure may take longer due to the additional challenges involved in accessing and fragmenting the stone.


Risks and Complications
While internal lithotripsy is considered a minimally invasive procedure, it does carry some risks and potential complications. These may include:
1. Infection: There is a risk of urinary tract infections (UTIs) following the procedure. Antibiotics are often prescribed to mitigate this risk.

2. Bleeding: Some bleeding may occur during or after the procedure, especially if the stone is large or if there is significant manipulation of the urinary tract.

3. Ureteral Injury: There is a small risk of injury to the ureter, which could lead to complications such as strictures (narrowing of the ureter) or perforation.

4. Stone Fragment Retention: Sometimes, not all fragments of the stone can be removed during the procedure. This may require additional treatments or procedures.

5. Postoperative Pain: Patients may experience discomfort or pain after the procedure, which is usually manageable with pain medication.

6. Need for Additional Procedures: In some cases, if the stone is particularly large or complicated, additional procedures may be necessary to completely remove all fragments.


Postoperative Considerations
After the procedure, patients are typically monitored for a short period before being discharged. It is common to have a stent placed in the ureter to help with urine flow and to minimize swelling. This stent may need to be removed after a few days to weeks, depending on the surgeon's recommendation.


Recovery and Follow-Up
Recovery time can vary, but many patients can return to normal activities within a few days. It is essential to follow the surgeon's postoperative instructions, including hydration and activity restrictions. Follow-up appointments are usually scheduled to monitor recovery and ensure that all stone fragments have been cleared.


Conclusion
In summary, internal lithotripsy is a generally safe and effective procedure for treating kidney stones, particularly when other methods have failed. While there are risks involved, they are typically manageable, and many patients experience significant relief from their symptoms. If your stone is indeed encased in tissue, it may require careful handling during the procedure, but with a skilled surgeon, the chances of a successful outcome are high. Always discuss your specific case and any concerns with your healthcare provider to ensure you have a clear understanding of the procedure and what to expect.