Laser lithotripsy is a medical procedure that precisely breaks down stones within the urinary tract. This treatment utilizes focused laser energy delivered through a thin scope, making it a minimally invasive approach to address various stone formations. It offers an alternative to more invasive surgical interventions for individuals experiencing discomfort and potential complications from urinary stones. The procedure fragments stones into pieces small enough to be passed naturally or removed by the surgeon.
How Laser Lithotripsy Works
Laser lithotripsy uses concentrated light energy to fragment urinary stones. During the procedure, a urologist guides a thin, flexible instrument called an endoscope, such as a ureteroscope or cystoscope, into the urinary tract to visualize the stone. A fine optical fiber is then threaded through the endoscope’s working channel, delivering laser energy directly to the stone.
The most common lasers are the Holmium:YAG (Ho:YAG) and the Thulium fiber laser (TFL). Holmium:YAG lasers emit infrared light at 2,100 nm, strongly absorbed by water. This creates a vapor bubble at the fiber tip, generating acoustic shock waves that mechanically fragment the stone. The laser energy also causes a photothermal effect, heating the stone and contributing to its destruction.
Thulium fiber lasers, operating around 1940 nm, also leverage strong water absorption. TFLs offer advantages like a wider range of pulse repetition rates and lower pulse energies, producing finer stone fragments, often called “dust,” and reducing stone movement (retropulsion). This facilitates their passage or removal, clearing the urinary tract.
Conditions Treated with Laser Lithotripsy
Laser lithotripsy is primarily used for stones in the kidneys, ureters, and bladder. It is recommended when stones are too large to pass, cause persistent pain, obstruct urine flow, or lead to recurrent infections. The procedure is effective across various stone sizes, locations, and compositions, including denser stones resistant to other methods.
This technique is frequently chosen for stones lodged in the ureter, the tube connecting the kidney to the bladder, where direct access allows for precise fragmentation. While other treatment options exist, laser lithotripsy is effective in achieving a “stone-free” status, especially for larger or more complex stones. The decision to use laser lithotripsy considers factors such as the stone’s characteristics and the patient’s overall health.
The Patient Experience
Preparation
Preparation for laser lithotripsy typically includes fasting for 8 to 12 hours prior to the scheduled time. Patients may also need to adjust or temporarily stop certain medications, especially blood thinners, to minimize bleeding risk during the procedure. Pre-operative evaluations, such as blood and urine tests and imaging studies, are performed to determine the stone’s exact location, size, and composition.
During the Procedure
Laser lithotripsy is generally performed under general anesthesia, ensuring the patient is asleep and pain-free during the procedure. A urologist inserts a thin, flexible scope, such as a ureteroscope, through the natural urinary opening (urethra) and bladder, guiding it to the stone’s location within the ureter or kidney. Once visualized, a laser fiber is passed through the scope, and laser energy breaks the stone into smaller pieces, which may then be collected with a small basket or allowed to pass naturally. In many cases, a temporary ureteral stent, a thin tube, is placed to help drain urine and facilitate the passage of any remaining stone fragments. The procedure is typically done in an outpatient setting, allowing most patients to return home the same day.
After the Procedure and Recovery
Following laser lithotripsy, patients are monitored in a recovery area until anesthesia effects wear off. Mild pain in the bladder or flank area is common and can be managed with prescribed medication. Blood in the urine is expected for a few days to a few weeks, gradually clearing as the urinary tract heals. Drinking plenty of fluids is encouraged to help flush out any remaining stone particles.
If a ureteral stent was placed, it may cause frequent urination or side pain, particularly during urination. The stent is usually removed in a follow-up office visit within a few days to several weeks. Most patients can resume normal daily activities within a day or two, though strenuous exercise might be advised against until blood in the urine subsides. Patients are often given a urine strainer to collect any passed stone fragments for analysis, aiding in future stone prevention.