Overview

Your doctor has found that you have a stone in your kidney or ureter. The ureter is the tube that connects your kidney to your bladder.

Kidney stones can be painful and cause infection or blood in your pee (urine). If the kidney stones are not removed, they can grow and damage your kidney or block your ureter.

You can read more about kidney stones on the NHS website.

If you have kidney stones, you might have a treatment called extra corporeal shock wave lithotripsy. This is a procedure to treat kidney stones.

The procedure uses shock waves to break your kidney stones into smaller particles. These particles can then pass out of your body in your pee.

Benefits of lithotripsy

You have lithotripsy as a day procedure. This means that you can come to hospital, have the procedure, and leave hospital on the same day.

You do not need to have surgery or an anaesthetic. This means that you spend less time in hospital and can recover more quickly.

Preparing to have a lithotripsy

• Allow at least 4 hours for your hospital visit.
• Drink normally and have a light meal before your appointment.
• Bring a dressing gown and slippers with you.
• Bring all the medicine that you usually take into hospital with you.
• Please do not wear any jewellery.
• If you plan to listen to or watch something on a device while you wait, please bring headphones so that other patients are not disturbed.

If you think you might be pregnant, tell the nurse and radiographer (the person who gives you your treatment) as soon as possible. The treatment uses X-rays that could damage your baby.

Medicines

Do not make any changes to your usual medicines. Continue to take them, unless you've been told not to. Remember to bring your medicines into hospital with you.

Tell the doctor or nurse if you take any medicines that you buy from a shop or pharmacy. This includes any herbal or homeopathic remedies.

If you take any medicines that thin your blood, tell the lithotripsy office at least 2 weeks before your procedure. This includes antiplatelet medicines (such as aspirin or clopidogrel) or anticoagulant medicines (warfarin or rivaroxaban). You might need to stop them for a short time before your treatment.

If you are allergic to any medicines, please tell the lithotripsy office.

Smoking

If you smoke, we ask you to stop smoking before your treatment.

Smoking increases the risk of developing a chest infection or deep vein thrombosis (DVT) (a blood clot in a vein) after the procedure. It can also delay wound healing because smoking reduces the amount of oxygen that reaches the tissues in your body.

You can speak to your nurse or call our stop smoking service on 020 7188 0995 or email gst-tr.stopsmoking@nhs.net

Arriving for your surgery

A doctor specialising in stone treatments will be available to give you advice and support if needed.

When you arrive, we will ask you to sit in the waiting area, or go for an X-ray to check the stone.

You will then sit in the waiting area until the nurse comes to get you ready for the procedure.

• We'll ask you to remove all your clothing and change into a gown and disposable underwear for the procedure. Secure lockers are available.
• A nurse will ask you some questions about your medical history. They will also take your blood pressure to make sure you're ready for your treatment.
• We'll ask you to give a sample of pee (urine). We use this to check for an infection and to make sure you're not pregnant.
• The nurse will give you some painkillers. These are usually tablets, and a small suppository. This is a small cone or tube, which needs to be put into your bottom. It melts to release painkillers.

During lithotripsy

The radiographer will complete the consent form with you, and remind you of the benefits and risks of the procedure.

Please ask any questions you have.

1. The radiographer will check the correct side and location of the stone.
2. We'll ask you to lie on the machine.
3. We'll put some warmed water on a plastic sheet underneath you.
4. We'll put small plastic stickers on your chest to monitor your heart rate during the procedure.
5. We use X-rays or ultrasound imaging to find and target the stone.
6. We'll put the lithotripsy probe under you on you to start the treatment.

When the lithotripsy begins, you can feel shock waves entering your body. People have described this as similar to having a finger flicking against their skin. Some people find it painful, but others do not feel pain. Please tell us if you find this uncomfortable and we can give you more painkillers.

The treatment lasts about 40 minutes and delivers about 4,000 shock waves. They pass through your body to break the stone into pieces (fragments). These fragments then pass out of your body in your pee.

After lithotripsy

After the procedure, we take you to a recovery area and give you something to eat and drink. You can leave hospital when you feel able to.

You need to spend the day resting. You should be able to return to your normal activities the next day.

To flush out stone fragments, make sure you drink plenty of fluid (mainly water). Try to drink over 2 litres (about 5 pints) of fluid each day. It is a good idea to keep drinking this amount of fluid in the long term. This can help to prevent you from getting more stones.

Symptoms to be aware of

You might see blood in your pee for 1 to 3 days after the procedure. This is normal and will clear.

You might feel a bit sore after the procedure. You can take painkillers, such as paracetamol and ibuprofen, to help with this. Always follow the instructions on the packet.

Risks of lithotripsy

As with any procedure, there are risks when you have lithotripsy. Most people do not have serious problems.

The procedure bruises the kidney slightly, so you might see blood in your pee afterwards. This should clear after a few days.

A stone or stone fragment might be left in your body after treatment. If this drops into your ureter, it can get stuck and cause pain. If this happens, you might need more treatment.

You might get an infection in your pee (urine).

A blood clot (haematoma) can sometimes form around the kidney, but this affects less than 1 in 100 people.

Giving your permission (consent)

The radiographer will talk to you about the risks and benefits of lithotripsy. The treatment might involve several sessions.

We want to involve you in decisions about your care and treatment. If you decide to have lithotripsy, we'll ask you to sign a consent form. This says that you understand what the treatment involves and agree to have it.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Other treatment options

Kidney stones in the ureter can be removed with a fibre-optic telescope. This procedure is called a ureteroscopy.

Larger stones can be removed with surgery. This involves the surgeon making a small cut (incision) in your back. You need to stay in hospital for longer after surgery and it takes more time to recover.

Please talk to your doctor or nurse if you would like more information about other treatment options.

Follow-up appointment

You will probably need more than 1 lithotripsy session to break the stones.

A few weeks after you have finished your lithotripsy treatment, you'll have a follow-up appointment in a clinic. We'll check how the treatment has worked.

We send you the follow-up appointment by post, text message or via MyChart. If you cannot come to this appointment, please contact the stone unit, phone: 020 7188 3220.