Laser Lithotripsy

What is laser lithotripsy?

Laser lithotripsy is a procedure that uses a laser to break up stones in your urinary tract. This includes your bladder, kidneys, ureters (tubes that carry pee from your kidneys to your bladder) and urethra (the tube that your pee goes through to leave your body).

Laser lithotripsy is often performed by a urologist during a ureteroscopy. They’ll insert a flexible laser fiber through a scope (a long tube with a camera on it) into your urinary tract to break up stones. They’ll remove the stone fragments with a small basket or other instruments. Providers don’t need to make any incisions (cuts in your skin) to perform this type of surgery.

Sometimes, lasers are also used to break up stones that a provider removes during a percutaneous nephrolithotomy, a procedure that remove kidney stones through an incision in your back.

Is laser lithotripsy major surgery?

Laser lithotripsy is usually done during a minimally invasive procedure. It’s not considered major surgery.

What’s the difference between laser lithotripsy and shock wave lithotripsy?

The difference between laser and shock wave lithotripsy is how your provider breaks up stones. Laser lithotripsy breaks stones up more directly, from inside of your body, with a laser. Shock wave lithotripsy breaks them up from outside of your body, with shock waves.

Laser lithotripsy is more effective at breaking up stones that shock wave lithotripsy can’t (due to size, location or hardness of the stone). But since laser lithotripsy requires a surgical device that goes inside your body, it carries some risks that shock wave lithotripsy doesn’t.

What happens before laser lithotripsy?

Your provider will give you instructions on how to prepare for laser lithotripsy. Following their directions closely can reduce your risk of complications. Before laser lithotripsy, your provider may ask you to:

• Not eat anything for eight hours or the night before the procedure (fast).
• Stop taking certain medications before the procedure.
• Ask someone to drive you home after the procedure.

Make sure you tell your provider about all the medications you take, including over-the-counter (OTC) and herbal supplements.

Sometimes during a scheduled lithotripsy, a provider has to place a stent to widen your ureter and reschedule the procedure for two to three weeks later.

What happens during laser lithotripsy?

During a laser lithotripsy performed with ureteroscopy, a provider will:

1. Put you under general anesthesia so you’ll be asleep during the procedure.
2. Insert a scope into your urethra.
3. Put a fiber through the scope with a laser on the end.
4. Break up the stone with the laser.
5. Collect the pieces of the stone in a basket.
6. Place a temporary tube (ureteral stent) that allows pee and small pieces of the stone to leave your body. Your provider will remove the stent at a later date (usually days to weeks later).
7. Remove the scope.

How long does laser lithotripsy take?

Laser lithotripsy usually takes one to two hours.

Is laser lithotripsy painful?

Since you’ll be under anesthesia, you shouldn’t feel pain during the procedure. You may have some pain or discomfort after the procedure.

What happens after laser lithotripsy?

After laser lithotripsy, providers will monitor you until it’s safe for you to go home. You’ll need someone to drive you. Your provider may prescribe pain medication, medications for stent discomfort and a few days of antibiotics.

What are the advantages of laser lithotripsy?

Advantages of laser lithotripsy over shock wave therapy include:

• Higher success rates.
• A lower chance of stone fragments blocking your ureter (steinstrasse).
• It’s less limited by location, hardness or size of stones.
• It’s effective on multiple stones.
• It can be used if you’re on blood thinners or pregnant.

What are the risks and side effects of laser lithotripsy?

After laser lithotripsy, it’s common to experience:

• Pain.
• Difficulty peeing.
• Blood in your pee (hematuria).
• Nausea and fatigue immediately after having anesthesia.

Complications of laser lithotripsy include:

• Ureter injury.
• Urinary tract infection (UTI).
• Stone fragments blocking your urinary tract.

How long does it take to recover from laser lithotripsy?

Most people are able to return to their usual activities around a week after laser lithotripsy. If you have a stent, some physical activities may cause discomfort or blood in your pee. Ask your provider what to expect.

How can I take care of myself after laser lithotripsy?

The best way to take care of yourself is to drink plenty of fluids. Follow any recommendations from your provider about when you can return to normal activities, how to take your medications and when to contact them.

When should I call my healthcare provider?

Contact your healthcare provider if you have any concerning symptoms. These include:

• Fever.
• Burning when you pee that lasts longer than a day or two.
• Lots of blood in your pee or pink-tinged pee that lasts longer than two to three days.

A note from Cleveland Clinic

Despite their small size, stones in your urinary tract can be extremely painful. Laser lithotripsy is an effective way to break up stones so you can get relief. Most of the time, laser lithotripsy is part of an outpatient procedure that takes just a few hours. Ask your provider about any concerns you have before or after the procedure.