Lithotripsy (Gr., 'stone-crushing'), the surgical operation of breaking up a stone in the bladder into such small fragments that they may readily be expelled by the urethra. Although the importance of such an operation has been recognised from the earliest time, a French surgeon, Civiale, who commenced his researches in 1817, but did not perform his first operation till 1824, may be regarded as the discoverer of lithotripsy. The instrument by which the disintegration of the stone is effected is introduced in the same manner as a catheter or sound into the bladder, and, after catching the stone, either bores, hammers, or crushes it to pieces. The stone is grasped by the blades of such an instrument as that shown in the figure, and the blades are then forcibly approximated to each other by means of a screw. The various fragments are gradually broken down in the same way till they are small enough to be discharged through a catheter introduced for the purpose.
Since the operation was first introduced, the instruments employed both for crushing the stone and for evacuating its fragments have gradually been improved; and experience has shown that this method is capable of superseding lithotomy in the adult in the vast majority of cases where an operation for stone is necessary.
It used to be considered advisable in the case of all but very small stones to crush and remove only a portion of the calculus at one time. To Bigelow of New York belongs the credit of recommending (in 1878) the method now adopted by almost all surgeons. He gave it the name of litholapaxy ('stone-evacuation'), but it only differs from lithotripsy in that the procedure is completed at one sitting. This improvement was an outcome of the teaching of Otis of New York, who found it possible to introduce instruments of larger size, and therefore more effective than had been previously considered safe.
In adults the only conditions which generally make lithotripsy unadvisable are 'extreme size, with hardness of structure in the calculus itself, and confirmed narrowness or other obstruction in the urinary passages, rendering the employment of adequate instruments impossible' (Sir H. Thomson). In children the risk attending lithotomy is much less than in adults; but the difficulties of lithotripsy, in consequence of the small size of the urethra, are much greater: in boys, therefore, the former operation is still generally preferred, except in the case of very small stones.