Shockwave lithotripsy (ESWL)

Diagram of ESWL

Extracorporeal shockwave lithotripsy uses focused sound waves to breakup your stones from outside your body. The advantage of this treatment approach is that instruments may not need to be introduced into your body (unless your stone is large, in which case a stent is usually placed at the time of surgery).

ESWL may be associated with less discomfort than other treatment options such as ureteroscopy or percutaneous nephrolithotripsy. However, ESWL does not usually have as high of a success rate as these other surgical treatment options and is more likely to require re-treatments. For more information on comparing the surgical options for kidney stones, see our comparison chart.

ESWL is easier to perform for stones that are visible on plain x-rays because this type of x-ray is used to target the stones during treatment. For stones that are not visible on plain x-ray, such as uric acid stones, special techniques can be used to allow ESWL to still be used. Stones that are less dense (which can be measured from CT scans) tend to respond better to ESWL than stones that are more dense.

ESWL can be used to treat both stones in the kidney and stones in the ureter. ESWL may not be as effective in patients who are obese because the increased body tissue can make it more difficult to visualize or treat stones.

Fast facts about ESWL:

  • Typical operative time: 1/2 hour
  • Usual hospital stay: No hospital stay, ESWL is outpatient surgery.
  • Average number of days before going back to work: 3.3 days
  • Average number of days before feeling back to normal: 8.1 days

Data regarding return to work and recovery from a study by Pearle and colleagues, Journal of Urology, 2005.

Photo of ESWL table

Photo of a Dornier ESWL table. Treatment head is positioned in the cutout on the right  side of table. The patient’s back would be in contact with the treatment head during a procedure.

Photo of ESWL treatment head closeup

Closeup view of  ESWL machine treatment head.

Xray of ESWL

X-ray image from shockwave lithotripsy procedure prior to initiation of shocks. Large round dark structure on the right of the image is the fluid filled treatment head placed against the patient’s skin to allow transmission of the shockwaves. The surgeon uses the aiming crosshairs to target the shockwaves at the stone to be treated. This patient had a previously placed ureteral stent which can be seen in the left side of the image.

Xray of ESWL after

X-ray image at the end of the same shockwave lithotripsy procedure showing the previously easily seen stones were well fragmented into multiple smaller pieces by the 2,500 shockwaves administered during the procedure.

223 Responses to Shockwave lithotripsy (ESWL)

  1. Su says:

    After lithotripsy, my 9 mm kidney stone didn’t appear on x Ray but showed up on sonogram ( one 5 mm and 4mm ). Is that possible . Before lithotripsy , the stone showed up on x Ray and not on sonogram .

  2. Anonymous says:

    There are some therapies that help stone removal after eswl. Inversion therapy was most effective one for me as my stones were in lower pole. I just inverted myself (legs up with wall, head down). Stone fragments moved to pelvis and then exited from kidney. But some frangments we’re lage enough to block ureter. So I got URD with dj stent placed. Finally 90% stone removed.

  3. Greg says:

    I have had Lithotripsy 7 times over the last 3 months and I am now scheduled to have my last stent removed. What I have learned: all Litho’s are different depending on the size and location of the stones and how many shockwaves you receive. Sometimes you may see a little blood a couple of times and have zero discomfort. Sometimes you may bleed a couple of days and just be sore and other times (twice for me) you may bleed for >week, suffer spasms, and feel like a horse kicked you in your back and have to pee every 10 minutes for days on end. My advice is to have your pain medication filled and ready, arrange to be off work for a week or so just in case, and pray for the best. Good luck.

  4. عماد says:

    ماهي كمية الاشعه التي يصدرها جهاز eswl وماهي نسبة ضررها ل الفني اللذي يعمل

  5. Darshini says:

    Hi all I have undergone Lithotripsy yesterday and I am taking pills.. Till now I have no pain and red urine passed.. Do you think that stones has broken into pieces?? Please I am expecting a reply

    • Debi says:

      I had it done yesterday also. The urine was red the first time I went and maybe a little bit the second time, but then it was clear. I wonder if the little bit of sand and tiny pieces are all that I will see in the strainer. My stone was 5 mm. Those little tiny pieces don’t really add up to that, so I’m assuming some of the particles must be pretty fine and fell through the skimmer without being captured. I do see some Sandy deposits. But any of that collected was on the first night afterward. I have to wait two weeks for the repeat x-ray to make sure it’s out but I have not needed any medication. Do you think all of it is out or do you think more will be coming? I had this done on December 28, and this is the next day.

  6. Lynn-M Halpin says:

    Hi, my name is Lynn-Marie, but pl call me Lynn. I have passed 50 stones in 10 yrs and had lithotripsy once on a 7mm stone. I came out with a soft ball size burn on my back. Dr said Lithotripsy wouldn’t work, so they used infrared rays! But he got the stone! I’m a producer of stones and Dr won’t help. Why won’t a Dr help me? I can’t drive to get pain meds while passing the dang things! They can’t fax or even call the pharmacy… U must be present to get any thing, you guys are so dang lucky! The hurting is the most hardest things to deal with and this on top of that I have Fibromyalgia, Heart disease, probs w/ pancreas and kidneys disease, 2stage B, whatever that means!! Y’all stay comfortable, love one another, and have a good evening!

  7. sharon says:

    On July 11 I had my 3d litho to break up a large (1 centimeter) They said they “got it”after each time. I dont think I will do this any more,this last one being really painful. The younger of my 3 docs told me its not good for my kidneys. I have only passed a black gooey substance. I feel the lithos are done to closly as the first was done May 23, the second..June 15 and now this one. I want to find out if that gooy stuff is a result of the litho…any thoughts??

  8. Marcia Fox says:

    How does one schedule a lithotripsy, through their Urologist? Can they go through a hospital that does this procedure. The earliest one will be our area is July 11th. If this is a portable unit, is there a schedule of where and when in our area it scheduled to be sooner than that date?

  9. Tami says:

    I had ESWL done yesterday on an 8 mm stone. My surgeon said he pulverized the stone. And if I understand correctly, that means it’s basically just sand at this point? I haven’t experienced any pain whatsoever at this point. I’m wondering if it might be wise to get my pain prescription filled today just in case. Can anyone speak to this?

    • Heather says:

      I just had it done 4 days ago and filled my Rx, just in case – but I have not needed to use it at all. I have had no blood in my urine, no pain, and I’m only passing a very, teeny, small amount of sand. Even ohhhh my Dr was pretty certain he got the 8mm one and the three smaller ones I had in my right kidney. I’m curious – how much sand did everyone see in the first few days?

      • I can’t believe you all had no pain. I had lithotripsy done Thursday for a 7mm and I’m still taking pain pills, a pill for ureter/bladder spasms and am only passing a few sand particles. I have a stent in until Friday when they will do another X-ray. I still have a little blood in my urine as well. I’m fairly miserable. I hope they don’t have to redo it. He claims he got it good so I’m hopeful that the pieces have just gone through the strainer. Ugh.

        • Criss says:

          I had more pain and blood in urine with a stent after a lithoscope procedure to remove a stone lodged in my ureter than pain from lithotripsy (no stent this time) to remove stone lodged in lower lobe of kidney..most common type stones I have. I feel weeker than normal but min pain and some gravel passing but most would be not seen because it broke up quite fine,,,thankfully, as passing stones can be excruciating pain at times

  10. Laura says:

    Why is this procedure needs to be done on a water-filled table?

    • Bob says:

      This procedure does not need to be come on a water-filled table. That is exclusive to the manufacturer of that technology. The better technology uses ultrasound gel as the conductive medium between the shock head and the patient’s skin. The other difference is not having to flip the patient.

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