Managing kidney stones: How effective is laser lithotripsy?

Laser lithotripsy offers direct, fast and accurate treatment of stones found within the urinary system. In this expert guide to the procedure, highly esteemed consultant urologist Mr Aasem Chaudry answers commonly asked questions about laser lithotripsy including how it is performed, success rates and possible complications.

What is laser lithotripsy?

Laser lithotripsy refers to the breaking up of kidney stones using a laser. As we all know, stones can affect any part of the urinary system and can be found in the kidneys, ureter (the tube connecting the kidney with the urinary bladder) or bladder.

When we use laser treatment, it means that we are able to see the stones directly by whatever means we have and vitally, the laser comes into direct contact with the stones. On activation of the laser, the stones start to fragment into very small pieces.

Is it an invasive procedure?

Laser lithotripsy can be performed for stones anywhere in the urinary tract as they can be present in the bladder, ureters or kidneys. We have different kinds of instruments which are used to get to these stones in the first place. Although these instruments are very fine and of small calibre, they still have to pass through the natural orifices; through the urethra into the bladder and when going into the ureter, also into the kidneys. These tools can be flexible or rigid, depending on the anatomy or the location of the stone.

This is an invasive procedure in the sense that an instrument is inserted into the body and this can cause discomfort and pain because all the genital organs are very sensitive. In fact, the whole urinary tract system is quite sensitive and so usually these procedures are performed under some kind of anaesthesia, which may be general or regional, in order to make the procedure painless. General anesthesia refers to when patients are put to sleep and regional anesthesia refers to situations where they are awake, but are unable to feel the sensations in certain parts of the body.

Who is an ideal candidate for laser lithotripsy?

Laser lithroscopy is well suited for patients who want quick, reliable treatment. As you may know, there are other modalities of treatment available for treating stones such as shockwave lithotripsy. This is another method of treatment which is non-invasive but is less reliable in terms of results. Additionally, there are certain stones which are very hard or dense and are therefore not suitable for shockwave lithotripsy.

Coming back to the subject of laser lithotripsy, it is indicated where the patients require quick, reliable clearance of stones or in cases where a more conservative method of treatment or shockwave lithotripsy has failed or is not feasible.

How effective is laser lithotripsy? Is it the first line of treatment for kidney stones?

Laser lithotripsy can be the first line of treatment but this depends on the location, composition and density of the stone as well as the preference of the patient. All of these factors have to be taken into account when making a decision about the best treatment plan for each patient.

In certain cases, laser lithotripsy may be the first line of management but in others it may be the second line or an auxiliary form of treatment. As this varies from patient to patient, it is not true to say that it is the first line of treatment in all cases and this must be discussed individually with your doctor.

In terms of success or utility of laser lithotripsy, this largely depends on whether the stone can be accessed directly by the instrument. If the stone can be reached reliably by the instrument, then very close to one hundred per cent of the stones can be fragmented.

The difficulty is that sometimes because of the location of the stone, you're not able to physically reach it and this means that the treatment will not be successful. For this reason, we always counsel the patients in advance that although the expectation is that it will be successful, there are sometimes situations where this may not be the case.

What are the potential risks or complications of this treatment?

Like any surgical intervention or procedure, there are some risks of complications which must always be taken into account. I will discuss the local complications (those related to the area where the procedure takes place) which are dependent on both the operator and the equipment, which has to be working in a correct manner for the procedure to be successful.

As I previously mentioned, the natural orifices are used to reach the stone and as such, there is a risk of potential damage to these small tubes, including the urethra and ureter. Although the instruments used are very fine, sometimes during passage these small tubes may be injured which occasionally can result in stricture formation later on in life, possibly affecting the urethra or the ureters. This is one of the issues we are very careful with.

The other common complication which happens in stone management is infection. Most stones have some bacteria lodged within them and when they are disturbed or fragmented, these bacteria are released into the surrounding fluid. Some bacteria can make their way into the bloodstream and so there is a small risk of infection from these procedures. For this reason, antibiotic cover is administered for all patients as this lowers the risk of infection.

Thirdly, as previously discussed, sometimes it is not possible to get directly to the stone and therefore failure of treatment can occur. Additionally, some of the stone fragments can fly away and hide from the visual field meaning clearance may be incomplete.

There are also certain laser specific complications which are operator dependent. The laser has to be used with a lot of precautions and as the laser cannot tell a stone from healthy tissue, should it be directed incorrectly, healthy tissue will be destroyed. This means the surgeon has to be very careful in directing the laser to the correct areas, to avoid perforations in the urinary system or damage to adjacent blood vessels or organs.

If you are suffering from stones within the urinary system and wish to book a consultation with Mr Chaudry to discuss the best treatment plan for you, you can do so by visiting his Top Doctors profile.