Editing Lithotripsy

{{Short description|Medical procedure for breaking up hardened masses}}{{Infobox medical intervention
|Name=Lithotripsy
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|ICD10=
|ICD9={{ICD9proc|98}}
|MedlinePlus=007113
|MeshID=D008096
|OPS301=
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|HCPCSlevel2=}}
'''Lithotripsy''' is a procedure involving the physical destruction of hardened masses like [[Kidney stone disease|kidney stones]],{{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" ([[wikt:litho-|litho-]] + [[wikt:τρίβω|τρίψω]] [tripso]).

== Uses ==
Lithotripsy is a [[non-invasive procedure]] used to break up hardened masses like [[kidney stone]]s,{{R|"MedlinePlus1"}} [[bezoar]]s{{R|"Hayashi1"}} or [[gallstone]]s.

== Contraindications ==
Commonly cited absolute contraindications to shock wave lithotripsy (SWL) include pregnancy, [[coagulopathy]] or use of [[platelet aggregation inhibitor]]s, [[aortic aneurysm]]s, severe untreated [[hypertension]], and untreated urinary tract infections.<ref>{{cite journal |last1=Reynolds |first1=Luke F. |last2=Kroczak |first2=Tad |last3=Pace |first3=Kenneth T. |title=Indications and contraindications for shock wave lithotripsy and how to improve outcomes |journal=Asian Journal of Urology |date=October 2018 |volume=5 |issue=4 |pages=256–263 |doi=10.1016/j.ajur.2018.08.006 |pmid=30364729 |pmc=6197584 }}</ref>

==Techniques==
* [[Extracorporeal shock wave therapy]] (lithotripsy)<ref>{{cite 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 |journal = The Cochrane Database of Systematic Reviews |volume = 2023 |issue = 8 |pages = CD007044 |date = August 2023 |pmid = 37526261 |pmc = 10392035 |doi = 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>{{cite 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 |journal = Journal of Endourology |volume = 26 |issue = 10 |pages = 1257–1263 |date = October 2012 |pmid = 22642568 |doi = 10.1089/end.2012.0217 }}</ref>
** [[Electro hydraulic lithotripsy]]
** Mechanical lithotripsy
** Ultrasonic lithotripsy: safer for small stones (<10&nbsp;mm)

==History==
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 [[urinary 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 at it. Endoscopy can use lasers as well as other modes of energy delivery: ultrasound or electrohydraulics.{{cn|date=January 2022}}

ESWL was first used on kidney stones in 1980. It 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]]ity or [[electromagnetic|electromagnetism]] generators. American Urological Association guidelines consider ESWL a potential primary treatment for stones between 4 mm and 2 cm.<ref name="webmd" />

Electrohydraulic lithotripsy is an industrial technique for fragmenting rocks by using electrodes to create shockwaves. It 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 | vauthors = Rebuck DA, Macejko A, Bhalani V, Ramos P, Nadler RB | title = The natural history of renal stone fragments following ureteroscopy | journal = Urology | volume = 77 | issue = 3 | pages = 564–568 | date = 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 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.

Endovascular lithotripsy is an [[angioplasty]] procedure using a balloon internally fitted with an ultrasound generator.<ref>Brinton TJ, Ali ZA, Hill JM et al. [https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036531 ''Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses''], Circulation, 2019;139:834-836</ref> It can be used in the reduction of very calcified [[coronary arteries]], with or without the combined usage of [[stent]]s.<ref>Hill JM, Kereiakes DJ, Shlofmitz RA et al.
[https://www.sciencedirect.com/science/article/pii/S0735109720373988 ''Intravascular lithotripsy for treatment of severely calcified coronary artery disease''], J Am Coll Cardiol, 2020;76: 2635-2646</ref>

== References ==
{{Reflist|refs=

<ref name="MedlinePlus1">{{MedlinePlusEncyclopedia|007113|Lithotripsy}}</ref>

<ref name="Hayashi1">{{cite journal | vauthors = Hayashi K, Ohara H, Naitoh I, Okumura F, Andoh T, Itoh T, Nakazawa T, Joh T | display-authors = 6 | title = Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report | journal = Cases Journal | volume = 1 | issue = 1 | pages = 385 | date = December 2008 | pmid = 19077219 | pmc = 2627813 | doi = 10.1186/1757-1626-1-385 | quote = There have been reports on the methods for treating bezoars, including surgical treatment, endoscopic lithotripsy, electrohydraulic lithotripsy, laser therapy, and even the use of extracorporeal shock wave lithotripsy (ESWL). | doi-access = free }}</ref>
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{{Urologic procedures}}
{{Digestive system procedures}}

[[Category:Digestive system procedures]]
[[Category:Urologic procedures]]