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A 2013 meta-analysis found LL can treat larger stones (> 2 cm) with good stone-free and complication rates. [5] Holmium laser lithotripsy had superior initial success and re-treatment rate compared to extracorporeal shock wave lithotripsy (ESWL) in a 2013 trial. [6]
Some of the passed fragments of a 1-cm calcium oxalate stone that was smashed using lithotripsy. The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones [3] (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse.
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. [7]
These advantages are especially apparent with stones greater than 10 mm (0.4 in) in diameter. However, because ureteroscopy of the upper ureter is much more challenging than ESWL, many urologists still prefer to use ESWL as a first-line treatment for stones of less than 10 mm, and ureteroscopy for those greater than 10 mm in diameter. [85]
Non-endoscopic open surgical procedures such as colon surgery where the operation field is very close to the adjacent retroperitoneal ureter is a well-known procedure where ureters can be injured, especially when surgical plans are distorted in conditions such as tethered colon cancer or advanced inflammatory bowel disease.
Lithotomy differs from lithotripsy, where the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by an acoustic pulse (extracorporeal shock wave lithotripsy), which is a non-invasive procedure. Because of these less invasive procedures, the use of lithotomy has decreased significantly in the modern era.