Lithotripsy: Difference between revisions

{{Short description|Medical procedure for breaking up hardened masses}}{{Infobox medical intervention

'''Lithotripsy''' is a medical procedure involving the physical destruction of hardened masses like [[kidneyKidney stone disease|kidney stones]]s,{{R|"MedlinePlus1"}} [[bezoar]]s{{R|"Hayashi1"}} or [[gallstone]]s, which may be done [[non-invasive procedure|non-invasively]]. The term is derived from the [[Greek language|Greek]] words meaning "breaking (or pulverizing) stones" ([[wiktionarywikt:litho-|litho-]] + [[wiktionarywikt:τρίβω|τρίψω]] [tripso]).

Lithotripsy is a procedure[[non-invasive involvingprocedure]] theused physicalto destructionbreak ofup hardened masses like [[kidney stone]]s,{{R|"MedlinePlus1"}} [[bezoar]]s{{R|"Hayashi1"}} or [[gallstone]]s.

* [[Extracorporeal shock wave therapy]] (lithotripsy)<ref name=Srisubat2014>{{Citecite journal |vauthors = Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P |title = Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones|last1 = Srisubat|first1 = A|date = 24 November 2014|journal = The Cochrane Database of Systematic Reviews |doivolume = 10.1002/14651858.CD007044.pub32023 |pmidissue = 254184178 |first2pages = S|last2 =CD007044 Potisat1|first3date = B|last3August =2023 Lojanapiwat|first4pmid = V|last437526261 = Setthawong|first5pmc = M|last510392035 = Laopaiboon|volume=11|issuedoi = 11|pages=10.1002/14651858.CD007044.pub4 }}</ref>

* Intracorporeal (endoscopic lithotripsy):

** [[Laser lithotripsy]] : effective for larger stones (> 2&nbsp;cm) with good stone-free and complication rates.<ref>{{Citecite journal |vauthors = Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK |title = Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis.|date = Oct 2012|journal = JJournal Endourol.|doiof =Endourology 10.1089/end.2012.0217|pmidvolume = 2264256826 |volumeissue =26 10 |pages=1257–63 |author=Aboumarzouk OM,1257–1263 Monga|date M,= KataOctober SG,2012 Traxer|pmid O,= Somani22642568 BK|issuedoi = 10.1089/end.2012.0217 }}</ref>

** [[ElectrohydraulicElectro hydraulic lithotripsy]]

** Mechanical [[Extracorporeal shock wave lithotripsy|lithotripsy]]

** Ultrasonic [[Extracorporeal shock wave lithotripsy|lithotripsy]] : safer for small stones (<10&nbsp;mm)

Surgery was the only method to remove stones too large to pass until [[France|French]] [[surgery|surgeon]] and [[urologist]] [[Jean Civiale]] in 1832 invented a [[surgical instrument]] (the [[Michaab|lithotrite]]) to crush stones inside the [[Urinaryurinary bladder|bladder]] without having to open the [[abdomen]]. To remove a calculus, Civiale inserted his instrument through the [[urethra]] and bored holes in the stone. Afterwards, he crushed it with the same instrument and aspirated the resulting fragments or let them flow normally with [[urine]].{{cn|date=January 2022}}

Lithotripsy replaced using lithotrites as the most common treatment beginning in the mid 1980s. In extracorporeal shock wave lithotripsy (ESWL), external shockwaves are focused at the stone to pulverize it.<ref name="webmd">{{Cite news|url=http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones|title=Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones|newspaper=WebMD |access-date=2017-01-14}}</ref> [[Ureteroscope|Ureteroscop]]ic methods use a rigid or flexible scope to reach the stone and direct mechanical or light energy isat appliedit. Endoscopy can use lasers as well as variousother modes of energy delivery: ultrasound, electrohydraulic,or and laserselectrohydraulics.{{cn|date=January 2022}}

ESWL was first used on kidney stones in 1980, and. itIt is also applied to gallstones and pancreatic stones. External shockwaves are focused and pulverize the stone which is located by imaging. The first shockwave lithotriptor approved for human use was the Dornier HM3 (human model 3) derived from a device used for testing aerospace parts. Second generation devices used [[piezoelectric|piezoelectricity]]ity or [[electromagnetic|electromagnetism]] generators. American Urological Association guidelines consider ESWL a potential primary treatment for stones between 4&nbsp; mm and 2&nbsp; cm.<ref name="webmd" />

Electrohydraulic lithotripsy is an industrial technique for fragmenting rocks by using electrodes to create shockwaves. thatIt 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.<ref name="RebuckMacejko2011">{{cite journal |last1 vauthors = Rebuck|first1=David DA, Macejko A.|last2=Macejko|first2=Amanda|last3=, Bhalani|first3=Vishal|last4= V, Ramos|first4=Patrick|last5= P, Nadler|first5=Robert B.RB | title = The Naturalnatural Historyhistory of Renalrenal Stonestone Fragmentsfragments Followingfollowing ureteroscopy Ureteroscopy| journal = Urology | volume = 77 | issue = 3 |year pages =2011 564–568 |pages date =564–8 March 2011 | pmid = 21109293 | doi = 10.1016/j.urology.2010.06.056 }}</ref>

[[Laser lithotripsy]] was introduced in the 1980s. [[Pulsed dye laser]]s emit 504&nbsp; nm ([[cyan]]-colored) light that is delivered to the stone by optical fibers through a scope. [[List of laser types#Solid-state lasers|Holmium:YAG]] lasers were developed more recently and produce smaller fragments.

== References ==