What happens if a kidney stone is resistant to lithotripsy?

Use Laser: Some types of stones do not fracture well with shockwave lithotripsy. If the stone needs to be treated then either ureteroscopy (scope from bladder up ureter) with laser can be used or a scope through the back directly into the kidney can be used. The latter procedure is for larger stones, usually over 2cm, and is called percutaneous nephrolithotomy (pcnl).

Laser: Typically the next step after a failed lithotripsy would be cystoscopy/ureteroscopy with laser ablation of the kidney. In this procedure, the stone would actually be visualized and broken apart by a laser. The smaller fragments will drain out. A stent may have to be left in place for a period of time in some instances, to insure that the ureter does not constrict after the procedure.