What are the complications of lithotripsy?

Complications of Lithotripsy

Lithotripsy can cause various complications including renal hematoma, hypertension, and tissue damage, with complication rates ranging from 20-43% depending on the technique used. 1

Common Complications

Immediate/Short-term Complications

• Hematuria

  • Nearly universal after shock wave lithotripsy (SWL)
  • Usually self-limiting within days

• Pain

  • Flank pain during stone passage
  • Stent-related discomfort (if stent placed)

• Steinstrasse (Stone Street)

  • Multiple stone fragments forming a column in the ureter
  • Can cause obstruction requiring additional intervention

• Vascular Trauma

  • Renal hematomas (subcapsular or perirenal)
  • More common with higher energy settings 2

• Infections

  • Urinary tract infections
  • Sepsis (rare but serious)
  • Requires antibiotic prophylaxis in high-risk patients

Long-term Complications

• Hypertension

  • Linked to renal scarring from shock wave damage 2
  • Reported in approximately 1-8% of patients

• Renal Function Impairment

  • Temporary elevation in serum creatinine
  • Usually resolves without permanent damage 3

• Diabetes Mellitus

  • Some studies suggest a potential link between SWL and new-onset diabetes 2
  • Remains controversial and requires further research

Comparison of Complication Rates by Technique

Extracorporeal Shock Wave Lithotripsy (ESWL)

• Overall complication rate: 20-36% 1
• Clavien I-II (minor) complications: 20% (95% CI: 11%-31%) 1
• Clavien III-V (major) complications: 2% (95% CI: 0.1%-4%) 1

Flexible Ureteroscopy (FURS)

• Overall complication rate: 22-43% 1
• Clavien I-II (minor) complications: 27% (95% CI: 12%-52%) 1
• Clavien III-V (major) complications: 8% (95% CI: 3%-16%) 1

Special Considerations in Pediatric Patients

• No significant difference in complication rates between FURS and ESWL in pediatric patients (RR = 1.18,95% CI: 0.76-1.82) 1
• No evidence of long-term renal scarring or growth impairment in children 4
• Hospital stay is longer with FURS compared to ESWL (mean difference = 0.25 days) 1

Risk Factors for Complications

• Stone size (larger stones = higher risk)
• Stone location (lower pole stones have lower clearance rates)
• Patient factors (obesity, bleeding disorders)
• Technical factors (energy settings, number of shock waves)

Prevention Strategies

1. Proper patient selection

   • Avoid SWL in patients with bleeding disorders
   • Consider alternative treatments for large stones (>2cm) 5

2. Technical optimization

   • Use lower power settings initially
   • Gradual ramping of shock wave energy
   • Limit total number of shock waves per session

3. Perioperative management

   • Antibiotic prophylaxis when indicated
   • Adequate hydration
   • Proper positioning during procedure

4. Follow-up monitoring

   • Blood pressure monitoring
   • Renal function assessment
   • Imaging to confirm stone clearance

Despite these potential complications, lithotripsy remains a generally safe and effective treatment for urinary stones, with the majority of complications being minor and self-limiting. The choice between ESWL and FURS should consider stone characteristics, patient factors, and available expertise, with both techniques showing comparable overall safety profiles 1.