Anesthesia is given during lithotripsy, so pain is usually minimal; however, colicky pain may appear later when stone fragments pass down the ureter. Therefore some discomfort is possible during the whole stone-removal process.
Main lithotripsy techniques:
- Extracorporeal shock-wave lithotripsy (ESWL)
- Suitable for renal stones ≤ 2 cm
- Stones are localized by X-ray or ultrasound and fractured with focused high-energy shock waves; the resulting sand-like particles are voided with urine.
- Ureteroscopic lithotripsy / stone extraction
- Rigid or flexible scopes (flexible scopes preferred for renal pelvis or calyceal stones)
- Used for radiolucent or ESWL-resistant stones < 2 cm; the scope is passed retrograde up to the renal collecting system, stones are fragmented and removed.
- Percutaneous nephrolithotomy (PCNL)
- Recommended for stones > 2 cm
- Under X-ray or ultrasound guidance a needle tract is created from the skin through the renal cortex; nephroscopy is performed and stones are broken (ultrasonic, laser or pneumatic) and extracted.
In summary, although some pain can occur, it is generally tolerable. After any of these procedures generous fluid intake and frequent voiding are essential to help clear the fragments.
| Aspect | Key Points |
|---|---|
| Intra-operative pain | Anesthesia provided; pain usually minimal. |
| Post-operative pain | Ureteral spasm may occur while fragments pass → colicky pain; generally tolerable. |
| ESWL ≤ 2 cm | X-ray/US localization; shock waves pulverize stone to sand, voided with urine. |
| Ureteroscopy < 2 cm | Flexible/rigid scope retrograde; fragment & extract radiolucent or ESWL-resistant stones. |
| PCNL > 2 cm | Percutaneous tract; nephroscopic ultrasonic/laser/pneumatic fragmentation & extraction. |
| Universal after-care | High fluid intake + frequent voiding to flush out fragments. |