Mechanisms
All forms of lithotripsy deliver energy to stone material so it cracks into smaller pieces that can pass in urine, be washed out, or be removed with graspers. The energy arrives by different physical routes.
In extracorporeal shockwave lithotripsy (ESWL), an external generator produces acoustic pulses that are focused onto the stone. Compression and tension waves create stress inside the calculus until it fractures. Shock coupling through skin and soft tissue is part of why obesity, spinal deformity, or very hard stones on CT can reduce effectiveness.
Treatment is usually on a dedicated table, often with sedation or light general anaesthesia, for roughly 30 to 45 minutes per session. Several sessions are sometimes required.
A holmium:YAG laser delivers infrared light down a thin fibre placed beside the stone through a ureteroscope. The stone surface absorbs the energy, producing a plasma bubble that fragments the calculus. The same laser platform can be set to fragment larger pieces or to dust very fine particles, depending on the clinical goal and surgeon preference.
Because the laser works in direct view through an endoscope, it is the standard intracorporeal tool for ureteric stones and for many renal stones where flexible navigation is possible.
During percutaneous nephrolithotomy (PCNL), a rigid nephroscope passes through a dilated tract from the skin into the kidney. Through the working channel, an ultrasonic lithotrite can apply high-frequency vibration with suction to break and aspirate fragments, while a pneumatic probe delivers a jackhammer-like impact. Holmium laser is often combined with these tools for complex stones.
For large bladder stones, a cystoscope-mounted lithotrite can crush the stone against another instrument, producing smaller chips that can be washed out or extracted. This is endoscopic litholapaxy, distinct from shockwave or laser approaches used in the ureter and kidney.
The clip below is drawn from the Urology NSW kidney stone patient information page and gives a broad overview of stone care. It is general information only.
The rooms can arrange a consultation to review imaging and outline which form of lithotripsy, if any, fits your situation.