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The laser method in kidney stone treatment is a modern endoscopic approach that provides a higher success rate especially in medium and large stones inside the ureter and kidney, directly targeting stone fragmentation. It offers more controlled and effective results according to the structure and location of the stone.
Among kidney stone breaking methods, sound wave treatment (ESWL) enables the stone to be fragmented with shock waves applied from outside the body and is generally preferred for small-sized stones. Its low anesthesia requirement and non-invasive structure offer important advantages.
The advantages of laser kidney stone treatment are that it provides high fragmentation power even in hard and large stones and increases the possibility of completely removing the stone. In addition, since it is applied under endoscopic imaging, it offers the opportunity for targeted intervention.
The comparison of sound wave and laser treatment varies according to the patient’s clinical condition, the size, hardness, and location of the stone. While sound wave may be sufficient in small stones, laser treatment provides a more effective and permanent solution in complicated and resistant stones.
How Is Laser Kidney Stone Treatment Applied?
Laser kidney stone treatment is an advanced method that enables large stones or stones stuck in the urinary tract to be broken effectively and precisely. The most commonly used technology in this method is the “holmium laser”. The application is generally performed during a procedure called “ureterorenoscopy” (URS). In this procedure, a thin and flexible camera device (ureteroscope) is advanced through the urinary tract up to the kidney. After the exact location of the stone is determined, the stone is divided into very small pieces using laser energy. These pieces are either removed or spontaneously expelled from the body through the urinary tract.
The laser method has a high success rate in both kidney and ureteral stones. It can also provide effective results regardless of the hardness or chemical structure of the stone. Usually, the stone can be completely fragmented in a single session. However, the procedure is performed under general or spinal anesthesia, and therefore the patient’s general health condition is important.
After laser treatment, the patient can generally return to normal life within 1-2 days. In some cases, a temporary urinary catheter may need to be inserted. Although the risk of bleeding is low, side effects such as infection, pain, or temporary blockages caused by stone fragments may be observed. Therefore, regular follow-up after the procedure is important. Laser stone breaking is a strong option preferred especially in cases where ESWL is unsuccessful or when the stone is very large.
How Is Kidney Stone Breaking with Sound Waves (ESWL) Performed?
ESWL (Extracorporeal Shock Wave Lithotripsy) is a non-surgical treatment method that fragments kidney stones with externally applied sound waves and generally does not require anesthesia. In this method, the patient lies on a special device, and the exact location of the stone is determined with the help of ultrasound or X-ray. Then, high-frequency shock waves are sent at certain intervals by focusing on the area where the stone is located. When these waves reach the stone, they divide the stone into small pieces, and these pieces are expelled from the body through the urinary tract over time.
The most important advantage of ESWL is that no incision is made during the procedure and hospitalization is mostly not required. The application time varies between 30 and 60 minutes on average. After the procedure, most patients can quickly return to their daily lives. However, complete fragmentation and expulsion of the stone from the body may take several weeks. During this period, pain, blood in the urine, or urinary tract infections may be seen during the passage of stone fragments.
The success rate of this method depends on the size, hardness, and location of the stone. Especially in stones smaller than 2 cm and located in the kidney, very successful results are achieved. However, the success rate may decrease in ureteral stones or stones with a very hard structure. Therefore, ESWL may not be suitable for every patient. Drinking plenty of fluids after treatment, increasing physical activity, and using painkillers or muscle relaxants recommended by the doctor may facilitate the stone passage process.
Advantages and Disadvantages of Laser Kidney Stone Treatment
Laser kidney stone treatment stands out as a highly effective method especially in the treatment of large and hard stones. In this method, in which holmium laser technology is used, the stone is directly observed and divided into small pieces with high-energy laser beams. This procedure is performed through a technique called ureterorenoscopy (URS), and the laser fiber is delivered directly to the point where the stone is located. Thus, the stone is broken with extreme precision and minimal tissue damage.
One of the most important advantages of this method is that it can be applied to almost every stone type and every location. Laser can provide successful results regardless of the hardness or structure of the stone. In addition, since the entire stone is divided into very small pieces, the risk of reformation also decreases. Most of the time, a successful result is achieved in a single session. The laser method becomes the most effective option especially in cases where other treatment methods are insufficient.
However, as with every medical application, laser treatment also has some disadvantages. First of all, the procedure is performed under general or spinal anesthesia, which may be risky for some patients. In addition, there is a risk of mild pain lasting a few days after the procedure, bleeding in the urine, or infection development. Besides, laser treatment is generally a more expensive method, and this technological infrastructure may not be available in some centers. Still, all these disadvantages can be minimized when applied with the right patient selection and by an experienced physician.
In general, laser treatment is a method with a high success rate preferred especially in large, complicated stones or stones that are difficult to break with ESWL.
Advantages and Disadvantages of Kidney Stone Breaking with Sound Waves
Kidney stone breaking with sound waves, medically called ESWL (Shock Wave Lithotripsy), is a non-surgical treatment method that enables stones to be divided into small pieces with externally applied high-frequency sound waves. This method can provide highly effective results especially for stones smaller than 2 cm and located in the kidney. One of the biggest advantages of ESWL is that no incision is made in the body during the application and it generally does not require anesthesia. In this respect, it is considered a non-invasive and comfortable method.
During treatment, the patient lies on a special device, and shock waves are sent by focusing on the area where the stone is located. The stone is fragmented thanks to these waves and is expelled from the body together with urine. The procedure is mostly applied as outpatient treatment, and patients can return home on the same day. In addition, ESWL offers a safe alternative for the elderly, children, or patients who carry a risk for general anesthesia.
However, ESWL is not effective in every situation. The success rate may decrease especially in very hard, large, or urinary-tract-stuck stones. In some patients, more than one session may be required for the stones to be completely fragmented. In addition, complications such as pain, bleeding in the urine, infection, or blockage of the urinary tract by the stone may be seen during the process of expelling stone fragments through the urinary tract. Although rare, mild tissue damage around the kidney may occur.
Laser or Sound Wave: Which Is More Effective in Kidney Stones?
Laser and sound wave methods in kidney stone treatment have become two widely used modern techniques thanks to technological developments. However, the superiority of these two methods over each other generally varies according to various factors such as the size, hardness, and location of the stone and the patient’s general health condition. Although both methods have high success rates in certain situations, it is difficult to give a single answer to the question of which is more effective. Therefore, it is necessary to reveal their differences with a comparative analysis.
The laser method is very successful especially in large, hard stones and stones stuck in the urinary tract. Since the stone is directly visualized and fragmented with laser, full control is achieved and the stone can be divided into very small pieces. The success rate in a single session is generally over 90%. In addition, being effective in all stone types regardless of shape or structure is a major advantage. However, the laser method generally requires general anesthesia and may cost more in some cases.
The ESWL method is ideal especially for small stones located in the middle or lower part of the kidney. Its biggest advantage is that it does not require a surgical procedure and generally does not require anesthesia. This is an important advantage especially for elderly patients or patients who carry anesthesia risk. However, if the stone is very large, hard, or located in the urinary canal, the success rate may decrease and more than one session may be required.
Which Method Is Suitable for Which Patient in Kidney Stone Treatment?
Although laser and sound wave methods used in kidney stone treatment are effective, they may not be equally suitable for every patient. At this point, factors such as the patient’s age, general health condition, past medical history, and suitability for anesthesia, as well as the characteristics of the stone, become decisive in the treatment decision. Evaluating which method is more suitable for which patients directly affects the success of treatment.
First of all, the size and location of the stone are among the most important criteria. The laser method provides more effective results in patients with stones larger than 2 cm because this method offers the opportunity to directly reach the area where the stone is located and completely fragment and clean the stone. On the other hand, in stones smaller than 2 cm and located in an easily accessible position inside the kidney, the sound wave (ESWL) method may be an option requiring less intervention.
The patient’s general health condition also plays a critical role in choosing the treatment method. For example, general anesthesia may be risky in patients with conditions such as heart disease, respiratory problems, or bleeding disorders. ESWL, which generally does not require anesthesia, is preferred for such patients. On the other hand, in young individuals with good general health, laser treatment stands out as both a more effective and safer option.
In pediatric patients, ESWL is generally the first choice because this method is less invasive and has a lower complication risk. However, in some cases, laser treatment may also be necessary in children. In addition, it is more reasonable to turn to laser treatment in patients who have previously undergone unsuccessful ESWL application for the same stone.
Is Recovery Faster After Laser or Sound Wave Treatment in Kidney Stone Treatment?
Laser and sound wave methods work with different mechanisms, and their recovery times also vary according to these differences.
The general tendency is that sound wave (ESWL) treatment offers a more comfortable recovery process. Because in this method, no instrument is inserted into the body, anesthesia is not required during the procedure, and the patient can often return to normal life on the same day. This is a serious advantage especially for desk workers or individuals with a light-paced life. However, there is an important detail here: expulsion of stone fragments from the body may take several weeks, which may occasionally cause problems such as pain, bleeding in the urine, or stone blockage. In other words, the recovery process may be less interventional but longer-lasting.
On the other hand, laser treatment generally promises a faster and more definitive recovery. Because the stones are directly seen, they can be completely fragmented, and most of the time no residual fragment remains in the body. This reduces the risk of experiencing pain again. After laser treatment, discomfort or mild pain may be felt while urinating for the first few days; however, most patients recover completely within 3-5 days and return to active life. If a stent (double J catheter) has been placed, this period may extend slightly, but overall recovery is still quite fast.
What Should Be Considered in Kidney Stone Treatment?
Getting maximum efficiency from laser or sound wave methods in kidney stone treatment is closely related not only to the technique applied but also to the habits the patient pays attention to before and after treatment. Although the success rate is high in both methods, conscious behavior by patients increases the effectiveness of treatment, accelerates the recovery process, and reduces the risk of stone recurrence.
First, the patient must be prepared before treatment as recommended by the doctor. Especially before procedures requiring anesthesia, such as laser treatment, simple but critical details such as stopping blood-thinning medications and coming on an empty stomach should be observed. Before ESWL, drinking plenty of fluids and having clean bowels may increase the effectiveness of the procedure.
One of the most important issues to pay attention to after treatment is drinking plenty of water. Drinking at least 2.5-3 liters of water daily allows stone fragments to be expelled from the body more easily and helps keep the urinary tract clean. In addition, it is beneficial to avoid intense exercises that may strain the kidneys but continue activities such as light walking.
Symptoms that may occur during the recovery process (such as pain, blood in the urine, and frequent urination) should be closely monitored, and if an unusual condition occurs, a doctor should be consulted without delay. If a stent was placed after laser treatment, it is important to have information about when this stent will be removed and in which situations it may cause problems.
Being conscious of the factors that trigger stone formation also affects long-term success. Avoiding foods rich in substances such as calcium oxalate, reducing salt consumption, exercising regularly, and having kidney controls at certain intervals with a doctor’s recommendation can prevent stones from forming again.
Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.
He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.
