IP-2024-000024 - [2025] EWHC 492 (IPEC)

Shockwave lithotripsy. This a non-invasive technique. Shockwaves in the form of pressure waves are applied to the exterior of the body, close to the kidney. The stone is broken by the treatment, typically over 45-60 minutes. The fragments are excreted naturally.

Ureteroscopy. A ureteroscope is inserted into the ureter. Usually the ureteroscope is contained in a ureteral access sheath. The flexible scope is extended beyond its sheath into the entrance to the kidney and in the case of some patients a little beyond the entrance, depending on the size and dilation of the kidney’s structure. An instrument which applies local lithotripsy is passed along a channel in the ureteroscope to reach the stone and to fragment it. The fragments are either removed mechanically by further instruments or are excreted.

Percutaneous nephrolithotomy (PCNL). PCNL is more invasive than URS. One or more incisions are made in the patient’s back to gain access to the kidney by keyhole surgery. A fine needle is inserted to pierce the kidney, then a dilator is passed along the opening made by the needle to make it large enough for a sheath to be inserted. The sheath is used by the surgeon as a conduit for a nephroscope, another specialist endoscope, this one used specifically for kidney stones.