2019. https://www.aafp.org/afp/2019/0415/p490.html. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Your surgeon or primary care provider may recommend blood tests to learn what caused the kidney stones. And remember, it will take several minutes for the pain to completely subside after the basic cause of pain, the dilated ureter, has been deflated. A surgeon uses special instruments passed through a tiny tube in your back to locate and remove stones from the kidney. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The smaller pieces of the kidney stone then pass through your urinary tract. In addition to flushing out the kidneys, apple cider vinegar may help ease pain caused . Lol how did I not notice the resemblance?! Nephrolithotripsy: Your surgeon uses sound waves or a laser to break up the stone and then vacuums up the pieces with a suction machine. The ureters are the tubes that connect the kidney to the bladder. We will show how this relatively small bulge of urine that we call our "liquid tool" can be activated to move a stone quickly (within minutes) through the ureter into the bladder with minimal pain. Fontenelle LF, et al. The stone is blocking the flow of urine out of your, Percutaneous nephrolithotomy or percutaneous nephrolithotripsy, Damage to the bladder, bowel, ureter, kidney, or. This subreddit is here to support those who suffer from kidney stones. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. Nephrolithiasis. at newsletters@mayoclinic.com. Some foods to include are: low-fat or fat-free milk products. This deflation temporarily relieves or even eliminates the pain for a while. Do this as much or as little as you can stand. Accessed Jan. 20, 2020. Elsevier 2020. https://www.clinicalkey.com. This liquid tool is activated as follows: when you jump vertically a few inches and land stiffly, with the ankles, knees, and hips locked, your body, including the ureters, stops suddenly. To separate accurate, usable information from less reliable folk remedies, this sub is focused science-based evidence, so if you're making any claims please cite published research. However, due to the curved route that the ureter takes as it enters the bladder, and the fact that the body is bent forward in the suspended Bump position, thereby at least partially compensating for the curve in the ureter, the Bump method may prove to be more effective in getting the stone into the bladder, especially if the stone is large. However, in its early development, when it is least painful and still of a non damaging size, it is the perfect "liquid tool" for accomplishing all 4 stated goals! Stones that are impairing kidney function may also require surgical removal. Continue this pattern for about 45 - 50 minutes, or until complete cessation of pain, whichever comes first. The doctor can use shock wave lithotripsy to blast the kidney stone into small pieces. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable. Preparing for surgery: Checklist. In some cases, you may need to stop these medications before your surgery. Knowing what type of kidney stones you have may help your care provider suggest ways to prevent future stones. Back up to the toilet seat (or other hard flat surface) as if to sit down, but instead of sitting completely down, stop for a second or two suspended 4 to 6 inches from the seat, then free fall the 4 to 6 inches to the seat, immediately rise to the previous position, hesitate a second or two, and free fall the 4 to 6 inches again. Should I see a specialist? At the very least maybe it will help with the pain at least temporarily. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy. Ask your urologist first if you are on any medications. I don't think the timing is super important, you just want hydraulic pressure in the system to help push it down and the jumping helps jostle it down with gravity. You'll likely see your surgeon 4 to 6 weeks after surgery for a follow-up visit. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water. You may opt-out of email communications at any time by clicking on How are they different from kidney stones? It was found that a stone in this size range could remain in this location for months without causing significant pain or other complications, contrary to a stone left in much larger sections of the ureter! The urinary system responds to this small bulge of urine by increasing the frequency of peristaltic waves in an attempt to dislodge the obstructing stone. McKean SC, et al., eds. Kidney Stone Treatment: What Should I Expect? You'll sleep through this procedure. To start the procedure, a specialized needle is inserted into a urine-collecting chamber of the kidney (calyx). You and your doctor should decide together that this "exercise" is appropriate for you. Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option to diagnose kidney stones. With it, a person can expect a much longer recovery time in comparison with, for example, a ureteroscopy. Campbell-Walsh-Wein Urology. time. Afterward, you'll drink lots of water to flush the stone pieces out in your urine. If it doesn't work, you might need to have the procedure repeated. The answer is a very emphatic yes! What's the chance that I'll develop another kidney stone? Through this catheter, your doctor can put a specialized tracer substance into the kidney that outlines structures inside the kidney so that they're more visible during imaging. and how do you combat the nausea? Can workout sit ups or jump-rope exercises aggravate kidney stones? Learn about the types, causes, and symptoms, as, Kidney stones can vary in size, shape, and colour. But there are downsides, said Dr. Mathew Sorenson, of the University of Washington School of Medicine in Seattle, one of the researchers on the new work. Like concrete flooring in garage or basement to jump on . Possible problems after a ureteroscopy include: If your stone is large or lithotripsy doesn't break it up enough, this surgery is an option. What, if anything, appears to worsen your symptoms? Simple abdominal X-rays are used less frequently because this kind of imaging test can miss small kidney stones. You'll get medicine beforehand to limit any pain or discomfort. Create an account to follow your favorite communities and start taking part in conversations. Nephrolithiasis. Complications of percutaneous nephrolithotomy and nephrolithotripsy include: During a ureteroscopy, a doctor passes a small telescope called ureteroscope through the urethra and bladder until it reaches the kidney stone. Small kidney stones that don't block your kidney or cause other problems can be treated by your family doctor. Next, the surgeon place a tube (sheath) along the path of the needle. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. dude this thing looks epic lol and yes the jump and bump method saved me also!!! Reaching or maintaining a moderate body weight will also reduce the risk of uric acid stones recurring. Mayo Clinic is a not-for-profit organization. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. This content does not have an English version. But previous work by the team has indicated patients can tolerate it. Mayo Clinic's comprehensive, multidisciplinary kidney stone program . Unlike a lot of Reddit communities this one is filled with awesome people and great tips. Since earlier work suggests the burst wave approach is tolerable, patients might not need pain medication afterward to deal with the procedure itself, Roberts said though they might need a pain reliever like acetaminophen (Tylenol) if passing the fragments proves uncomfortable. Dr. Jason Cogdill answered Nephrology and Dialysis 18 years experience Only one way out: There is only one natural way out. A person will receive general anesthesia or sedation before the procedure begins. Right now, many kidney stones can be treated with a procedure called shock wave lithotripsy. Thankfully most of my pain was in my bladder, especially before/during/after peeing, but towards the end was pretty much constant and radiated out to my lower back on the right side. After this procedure, a person can expect to spend several days in the hospital. You will be given something so that you wont be awake during this surgery. After about 25 - 30 minutes from the time you began to drink the lukewarm water, you are ready for step number two. Lithotripsy treats kidney stones by sending focused ultrasonic energy or shock waves directly to the stone first located with fluoroscopy (a type of X-ray "movie") or ultrasound (high frequency sound waves). This subreddit is here to support those who suffer from kidney stones. In: Conn's Current Therapy 2020. If your doctor suspects that you have a kidney stone, you may have diagnostic tests and procedures, such as: Imaging. BOOM! Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require more-extensive treatment. Will I need medication to treat my condition? However, there are other preventive measures, depending on the type of kidney stone a person keeps having: To prevent oxalate stones, a person should reduce or avoid consumption of these foods: They should also avoid foods high in sodium and reduce the amount of animal protein they consume. Percutaneous nephrolithotomy is used most often for larger stones or when less-invasive procedures don't work or aren't possible. This procedure is not invasive, and therefore a person can expect to get back to their normal activities within 2 days. Ultrasound was on Friday (2 days ago), I think it was at the base of the penis and that's why it didn't show up. Gupta noted that the study did not actually test the hoped-for, real-world scenario: Using the technique without anesthesia. By using our website, you consent to our use of cookies. ", National Institute of Diabetes and Digestive and Kidney Diseases: "Treatment for Kidney Stones in Adults. Large kidney stones block more than one branch of the collecting system of the kidney. Elsevier; 2020. https://www.clinicalkey.com. That gave me hope that if I kept going it might work and thankfully it did! HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Kidney stones in adults: Surgical management of kidney and ureteral stones. All rights reserved. These waves go through your skin and break up the stone into small pieces. One important me "Percutaneous Nephrolithotomy/Nephrolithotripsy. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Learn more here. And nine stones (39%) were completely broken down to that degree. Some patients showed mild bleeding, with small amounts of blood in the urine. health information, we will treat all of that information as protected health Start Here. Because ureteroscopy requires anesthesia, the study patients were under when the ultrasound bursts were applied, for up to 10 minutes. Or your doctor may recommend treatment of the condition that's causing your parathyroid gland to overproduce the hormone. So basically what helped ease the pain and pass the stone was the JUMP & BUMP method. ", National Kidney Foundation: "Kidney Stone Treatment: Shock Wave Lithotripsy." You may need general or local anesthesia during this procedure. Open surgery is the most invasive type of kidney stone surgery. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. You might have to pee through a strainer to catch pieces of the stone so they can test them. Since that night I have never gone to the ER for a stone as I've always been able to get it to move enough to let urine flow. The procedure creates a passageway from the skin on the back to the kidney. You may have ultrasound, X-ray or a CT scan to check for any stones that may be left and to make sure that urine is draining as usual from the kidney. All rights reserved. Your doctor will pass the scope through your bladder and ureter into your kidney. In most cases, a considerable period of time elapses, sometimes several hours, before the distention of the obstructed ureter becomes so great as to cause extremely intense pain. Accessed Jan. 20, 2020. Accessed Jan. 20, 2020. The stones are broken into tiny pieces. To provide you with the most relevant and helpful information, and understand which They will remove the stone through the opening. And they found that roller coasters up and down and around - they bump those kidney stones right through your system. A job for miracle medicine? They will likely need to take 1 week off work. To separate accurate, usable information from less reliable folk remedies, this sub is focused science-based evidence, so if you're making any claims please cite published research. https://www.urologyhealth.org/urologic-conditions/kidney-stones. Imaging tests may show kidney stones in your urinary tract. "Percutaneous nephrolithotomy: What you can expect. After a few seconds of time and a few repetitions of the described movements, the onion is moved to the foot of the hose. https://imgur.com/a/RBiiAiW It was intense pain for a split second as it exited, followed by the most glorious relief I've ever felt. Also, memorize all steps and make sure you understand the rationale for each step. Livestrong - Alternative Treatment For Kidney Stones, The Kidney Stone Website - Eliminating The Kidney Stone, Natural News 10/11/2012 - Pumpkin Discourages Kidney Stones, Natural News 10/31/2012 - Herbal Teas And Grocery Foods Dissolve Kidney Stones And Reverse Renal Failure, Natural News 3/29/2013 - How To Prevent Kidney Stones With Everyday Foods. Kidney stones are crystallized minerals that form in the kidneys. There are four main types of kidney surgery: percutaneous nephrolithotomy and nephrolithotripsy, ureteroscopy, shockwave lithotripsy, and open surgery. It involves threading a thin scope through the urethra, up to the location of the kidney stone; instruments are used to either snare the stone or break it into fragments that can be removed. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. It's great. Long ago i figured out the jump around method in the middle of a painful night. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. For people with a history of kidney stones, doctors usually recommend drinking enough fluids to pass about 2.1 quarts (2 liters) of urine a day. Treatment for kidney stones varies, depending on the type of stone and the cause. Thank you for sharing! Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Press J to jump to the feed. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Our caring team of Mayo Clinic experts can help you with your kidney stones-related health concerns. You're bleeding or you have an infection. Thanks to the YouTuber who made the video!! Kidney stones patient guide. Be prepared for the pain to return possibly 30 to 60 minutes later, as the ureter slowly re inflates with urine above the obstruction. However, there is some relatively new info on stone pain about which some sufferers may not be aware. Open surgery is rarely done for kidney stones anymore. Staying hydrated and drinking plenty of water throughout the day should be enough to prevent this type of kidney stone from developing. So far, it's been able to completely, or nearly completely, break up stones within 10 minutes. Nov. 3, 2021. Currently, many pain experts say that even though the described abrasion and cutting may cause damage such as scarring of the ureters, there is no immediate pain from this passage. You may have a flexible tube (catheter) passed through the urethra, bladder and ureter into the kidneys. Our Updates Are Continuous. Read More I would do 60 jumps and then drink more water, rinse and repeat. Make sure you understand the risks and benefits of each of your treatment options. The procedure is called percutaneous nephrolithotomy, which involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. 12th ed. Anyway guys I'm here to answer any questions and share this amazing strategy. Has anyone else in your family had kidney stones? How long will I need to stay in the hospital afterward? Immediately repeat the jump. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This helps decrease the pain associated with the blockage (i.e. Vigorous walking, which probably acts in somewhat the same way as the vibrator; And continuous (up to seven days and nights) oral consumption of a combination of several different smooth muscle relaxants. In this case, you may be given a medication that numbs only a small area of your body (local anesthesia) in the radiology department. If you think you might become nauseous, have a good supply of fast acting anti emetic suppositories on hand and place one rectally prior to drinking the lukewarm water. They then locate and remove the stone. The procedure creates a passageway from the skin on the back to the kidney. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Slideshow: The Best and Worst Juices for Your Health, Slideshow: Foods and Drinks That Make You Gotta Go, Drinking More Water? Most small kidney stones won't require invasive treatment. Advertising revenue supports our not-for-profit mission. The surgeon may then place a different tube, called a nephrostomy tube, in this same passageway. In other words, if the object is at rest, it tries to stay at rest. They include percutaneous nephrolithotomy and nephrolithotripsy, ureteroscopy, shockwave lithotripsy, and open surgery. If you notice blood or thick clumps of ketchup-like blood in your urine or drainage tube, go to the emergency department. https://www.asahq.org/madeforthismoment/preparing-for-surgery/prep/preparing-for-surgery-checklist/. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Options in the management of renal and ureteral stones in adults. If you have a nephrostomy tube for draining the kidney, you may return sooner. I will not burden the reader with details of the urinary system, such as size of the kidneys, ureters, bladder, different types of stones, and so forth, because you probably know the basic information. Copyright 2005 - Through - 2019 by Alternative-Health-Group.Org. Your in-depth digestive health guide will be in your inbox shortly. Many years ago, before the development of commercial cold storage, folks would buy relatively large quantities of jumbo sweet onions at harvest time, place them in old discarded, nylon hose, and hang them from the ceiling so that each individual onion was "air cured." Are: low-fat or fat-free milk products medical News Today has strict sourcing and... Blood or thick clumps of ketchup-like blood in your inbox shortly it a... To that degree the lukewarm water, you are on any medications cider may... By Using our website, you may need to take 1 week off.... Kidney or cause other problems can be treated with a procedure called shock wave lithotripsy. exercises kidney. Your back to locate and remove stones from the skin on the back to and. And newsletters from Mayo Clinic studies of tests and procedures, such as: imaging types causes... Conditions and Privacy Policy linked below stones anymore decide together that this `` exercise '' is for! Lt is sometimes called ESWL: Extracorporeal shock wave lithotripsy. wo n't require invasive treatment, bladder and into... Kidney and ureteral stones in adults tube in your inbox shortly thick clumps of ketchup-like in. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper of... Extracorporeal shock wave lithotripsy to blast the kidney your urine output to make sure that you wont be during... Can vary in size, shape, and open surgery the middle of a night! Ultrasound, a noninvasive test that is quick and easy to perform, another. Different from kidney stones anymore read more I would do 60 jumps then... Pieces of the condition that 's causing your parathyroid gland jump and bump kidney stone removal overproduce the hormone basement to on. Of your treatment options the medical term used to describe stones occurring in the hospital may that. A tiny tube in your urinary tract break up the stone so they test. Began to drink the lukewarm water, rinse and repeat or nearly,. Appears to worsen your symptoms doctor will pass the stone pieces out in your urinary tract adults: management. Locate and remove stones from the skin on the back to locate and remove stones the! In-Depth Digestive health guide will be in your urine output to make sure understand! Extracorporeal shock wave lithotripsy. procedure repeated have may help ease pain caused and... Clicking on how are they different from kidney stones anymore stone program Clinic studies of tests and procedures, as... Stop these medications before your surgery is inserted into a urine-collecting chamber the. New info on stone pain about which some sufferers may not be aware memorize all steps make. To make sure you understand the risks and benefits of each of treatment. They can test them 18 years experience only one way out is at rest, it to. Digestive and kidney Diseases: `` kidney stone treatment: shock wave lithotripsy to blast the.... To pee through a tiny tube in your back to the emergency department noninvasive test that is and... Or as little as you can stand: Using the technique without anesthesia the urethra, and! Blast the kidney, you might have to pee through a tiny tube in back... In addition to flushing out the kidneys, apple cider vinegar may ease... With awesome people and great tips can test them treatment options tubes that connect the kidney be! Nephrolithotomy and nephrolithotripsy, ureteroscopy, shockwave lithotripsy, and symptoms, as kidney! Most small kidney stones are crystallized minerals that form in the urine to include are: low-fat or milk! To overproduce the hormone potential or actual medical emergencies, immediately call 911 your! Urolithiasis is the medical term used to describe stones occurring in the hospital?... Understand which they will likely need to stop these medications before your surgery, treat or manage.... Healthtap uses cookies to enhance your site experience and for analytics and advertising purposes, or until complete cessation pain... That this `` exercise '' is appropriate for you check out these best-sellers and special on! Previous work by the team has indicated patients can tolerate it 6 weeks after surgery for a.... Is quick and easy to perform, is another imaging option to diagnose kidney stones,! Kidney Diseases: `` treatment for kidney stones the type of kidney and ureteral in... Anesthesia or sedation before the procedure begins or basement to jump on ( )... The pain and pass the scope through your system of ketchup-like blood your... Our website, you may have diagnostic tests and procedures, such as: imaging might work and thankfully did! A person will receive general anesthesia or sedation before the procedure creates a from... I 'll develop another kidney stone program help with the pain for a while sure you the... Family had kidney stones wo n't require invasive treatment vary in size shape. Completely broken down to that degree and procedures to help prevent, detect, treat or manage Conditions a. Amazing strategy a tube ( sheath ) along the path of the kidney ( calyx ),! Stones ( 39 % ) were completely broken down to that degree completely, break up within. Looks epic lol and yes the jump around method in the management of kidney stones you have may help pain... Should decide together that this `` exercise '' is appropriate for you clicking on how are they from. Comparison with, for example, a specialized needle is inserted into a urine-collecting chamber the! Follow your favorite communities and start taking part in conversations receive general anesthesia or sedation the. 'S causing your parathyroid gland to overproduce the hormone temporarily relieves or even eliminates the pain least. Of renal and ureteral stones in your urine output to make sure you understand the rationale for each.. And make sure you understand the risks and benefits of each of your options. Stones wo n't require invasive treatment nephrolithotomy and nephrolithotripsy, ureteroscopy, shockwave lithotripsy, and open surgery is most... This procedure is not invasive, and therefore a person can expect to get to!, there is only one natural way out: there is some relatively new info on pain! Yes the jump and bump method saved me also!!!!!!! Yes the jump & bump method # x27 ; s comprehensive, multidisciplinary kidney stone each of your treatment.. Along the path of the collecting system of the condition that 's causing your parathyroid gland to overproduce hormone! Bladder and ureter into the kidneys, apple cider vinegar may jump and bump kidney stone removal your care may! Relatively new info on stone pain about which some sufferers may not be aware and this... It did receive general anesthesia or sedation before the procedure begins understand which they will likely need to at... Stone so they can test them example, a person can expect a much longer time. Procedure creates a passageway from the time you began to drink the water. - 30 minutes from the time you began to drink the lukewarm water, you to... ( MFMER ) a much longer recovery time in comparison with, for up to 10.. Treatment for kidney stones prevent, detect, treat or manage Conditions you will in. Benefits of each of your treatment options throughout the day should be enough to prevent type... Procedures, such as: imaging to the Terms and Conditions and Privacy Policy linked below of... For larger stones or when less-invasive procedures do n't work jump and bump kidney stone removal are n't possible of. Is appropriate for you thanks to the emergency department pieces of the kidney to the emergency department general or anesthesia. - 30 minutes from the skin on the type of kidney stone program they will likely need to 1... Your site experience and for analytics and advertising purposes these waves go through your bladder and ureter into kidney... Given something so that you wont be awake during this surgery requires,! Pass through your system develop another kidney stone into small pieces, ureteroscopy, shockwave lithotripsy, symptoms... Nephrology and Dialysis 18 years experience only one way out: there is some relatively info... Require surgical removal lol and yes the jump around method in the management of renal and ureteral stones in urine! Urine output to make sure you understand the risks and benefits of each of your treatment.! Is the medical term used to describe stones occurring in the urinary tract garage or basement to jump on adults... Guide will be in your family doctor special instruments passed through a strainer to catch pieces of condition... Least temporarily surgeon or primary care provider suggest ways to prevent future stones chance that 'll... ( stent ) in the kidneys into small pieces skin on the type of kidney:. Under when the ultrasound bursts were applied, for up to 10 minutes long will jump and bump kidney stone removal need to 1! Describe stones occurring in the hospital afterward low-fat or fat-free milk products vinegar may help ease pain caused time..., the surgeon may then place a small tube ( sheath ) along the path of the kidney stone.! Used to describe stones occurring in the management of renal and ureteral stones adults. Depending on the back to locate and remove stones from the skin on the back to their normal activities 2! Work, you may have diagnostic tests and procedures to help prevent, detect, treat or Conditions... Treat all of that information as protected health start here are used less frequently because this kind imaging. It tries to stay in the middle of a painful night treat or manage Conditions at very., is another imaging option to diagnose kidney stones time in comparison with, for up 10. A person can expect to spend several days in the kidneys, apple cider vinegar help. Some relatively new info on stone pain about which some sufferers may not be aware nephrolithotripsy, ureteroscopy shockwave!