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.

143 Responses to Shockwave lithotripsy (ESWL)

  1. Dave B says:

    3/30/15 I had a 7mm stone stuck in the right ureter tube and it HURT! Emergency room cat scan showed the 7mm stone plus some other smaller ones and a 10mm plus smaller ones on the left. Had ESWL on April 2 after a couple days on strong pain meds and one night in hospital. Had the stone blasted and felt fine!

    8.26.15 had the 10mm stone on the left blasted in the morning and ate a nice lunch. Early afternoon threw up the nice lunch and had a migraine set in that tore me up the rest of the day and all night until about 10:00 the next morning. Now is Friday 8/28/15 at about 11:20AM an I am very tired and achy but looking forward to feeling better in a few days. Doctor has me on Flomax to help pass fragments and ketorolac 10mg for pin but I have been doing okay with just tylenol instead.

    I did not know that general anesthesia can and does cause strong migraines! I know it now! Be advised that you might get the migraine too if put to sleep for the stone blasting.

  2. Chris says:

    I just had shock wave therapy done today and boy am I in pain. Besides peeing blood, abdomen pain, and lower back pain, light headed and sick to my stomach because all the meds they have me on….I might feel great lol. I’ve fought these 2 stones for over a month now. They shocked and broke up my 7mm one but I still have a 3mm one in my kidney they they said would probably pass on its own now. I’m in severe pain and the meds and heating pad really isn’t helping much so I could really use some advice on getting to feel better. It’s 7/23/15 and I got out of surgery and discharged at around 5:30pm and it is now after midnight and the pain has not eased up any yet. I hope and pray that your guys are not dealing or suffering like I have been. God bless and keep me in your prayers please.

  3. gsngh says:

    I have stones in both the kidneys, doctor advised me for shockwaves, when I red about side effect like hypertension, diabetes, high BP, damage of kidney.
    Is this treatment so much risky, please advice if someone had these side effects after ESWL.

  4. Jen says:

    I had a stent and ESWL on Wednesday July 1. Everything went smooth. All day though I was vomiting and blood in my urine. I saw little fragments. I know that my stone was at least 10mm, and I haven’t passed the whole stone yet. Doctor said more than likely I will have to have it again. I ended up going to the ER that night because it hurt so much with I had to pee. They gave me tolterodine for the bladder spasms as vesicare is not covered under my insurance with an authorization. Here it is 5 days later and it still hurts when I urinate that I can feel it all the way into my kidney. I had planned on going back to work tomorrow, but due to the physicality of my job, that will be on hold. The stent is what irritates the most. I can actually feel it in different spots. Can’t wait until that can be removed.

  5. Lynn says:

    I had a kidney stone 11mm first the dr. said he was going to blast it. it did NOT do a thing to the stone. so dr. said its big n very hard so said he could remove it or try lazer. all the lazer did was break it up to fragments that were to big to pass. they tried a total of 4 lazer treatments in the past 7 weeks and nothing has passed yet. he put in a stent each time and this last time 2 days ago my stent came out. how many times can your kidney stones have this laser or shock treatments before it affects your kidney?

  6. Jennifer says:

    I had a 5.5mm stone broken up on Thursday. Until today I have just been very groggy still with some mild tenderness to my left side and abdomen. This evening though, I suddenly eel like maybe I am passing a fragment…not sure since this is my first time. The pain is very low near the urethral opening and comes in waves. I feel the need to pee even when I don’t have to go. Am I’m passing a fragment? How long does it take? This pain has been there for about an hour now…I’m just pushing fluids like crazy!

    • Roger says:

      I had Lithotripsy surgery in May. After I passed fragments for about two weeks. Then I was fine. About 3 weeks ago I have the same feeling like you are having. a real bad urge to pee, but don’t have to. this comes and goes and at times is pretty intense. I have had 2 urine samples done and they come back fine. my doctor says there are still some fragments just outside my bladder and is causing this. I have been this way going on 3 weeks and it is very aggravating. don’t know what else to do

  7. hafeez says:

    i was feeling very painful and lower back before i do letho tripcy a month before now i am felling litle comfort but not 100 person how much time it takes to stone was 8.8 mm in my leff blader after letho tripcy some pieces removed with urine.what other thinks i do to be fit any preventions.plz reply me?

  8. Ozzy says:

    I had my shock waves treatment on 6/24/2015 I had to kiedney stones 6 to 7 mm we’ll I think it weren’t well they had to go in a camara and some dye to locate the stones and my told me they got them both and that it when great but all see what happends the days to come

  9. Bob Mc says:

    I am a 67 year old male and scheduled for ESWL on June 29th for a stone that is 16mm. Doc says I may need two treatments to bust this one up. I have had two lithotripsy procedures prior to this and everything passed easily after the treatments. However, this is the largest stone I have had. The other stones were like 7 and 8 mm. I have had only one treatment to eradicate the other stones. This one has me a bit concerned. The other stones were about 10 and 12 years ago so it’s been a while since having this procedure. I am older now and not in as good of shape as I once was. God is in control.

    • Guest says:

      I had a 1.9 cm stone and had the 2nd treatment a week ago…piece of cake. Don’t worry yourself…I had one 7 mm 2 years ago and had the lithotripsy and the ESWL was much, much easier and much less wincing and bleeding. The worst part for me was getting over the anesthesia. I woke up from the 2nd treatment, and yes, I was told one treatment on a large stone would not do it. My only issue now the fragments have settled into the cove in the kidney and will take some time to flush out.

    • keith says:

      Hi Bob, Yes I have had 6 surgeries so far and now have a 13mm (size of a nickel) right next to my right kidney.. Here we go again…. Last wed. they put the stent in and now I have to wait 10+ days to get a litho… In pain again!!! Im afraid that it might not be successful…..

  10. Joe says:

    Would a doctor force someone to try to pass a kidney stone naturally rather than have surgery or scope? I mean if I don’t want to risk extreme pain and nausea, will a doctor give me options?

    • Juliet says:

      My doctor gave me the option of waiting for it to pass, or having lithotripsy. I’m recovering from the litho I had this morning.

      • Iris says:

        Hi, just reading all the comments regarding lithotripsy. I have a 4 mm stone in my left kidney that makes me very nervous. Urologist said she would do litho if I wanted to but didn’t sound too eager. Are you recovering well and how big was your stone?

  11. Lois says:

    Hi Karen, did you get my reply to your posting?Lois

  12. Sally says:

    Had 7.5 mm left lower pole stone shocked last Wed. Still have not passed any stones. How long does it take to start passing any fragments when stone was in lower pole?

    • John says:

      Hi Sally
      I just had it lithopripsy yesterday on stone in lower left pole. These can be hard to treat because gravity keeps them there.
      My doctor showed me a position to lie on the side of the bed on your tummy with your arms folder on the floor. He said it can improve shifting stones in this region.
      I’m in a lot of pain still :-(. Hope you go ok there.

  13. I just had lithotripsy on my left kidney. Had a 7 mm stone. Surgery we well. They removed my stent too.Thank God !! Passed some small pieces of my stone. Its nice to be able to pee again without it hurting All the meds I’m taking make me feel weak and light headed but so far no real pain or complications , just some bruising on my left back . Had a great doctor ( he had done hundreds before mine) hopefully this is now in the past. I am a spiritual person and had to just give this one to God. This one was my third stone. The others were passed but not without PAIN ! I feel lucky from some the stories i’ve read on this site

  14. Karen says:

    Hi, I had a lithotripsy on Thursday 5/28/15. My stone was 7 mm, the first day I felt pretty good, but now it’s Saturday & feeling flank pain & lower back pain, guess you could say it’s more of a uncomfortable feeling. Today I have passed more fragments than yesterday. I am feeling sick to my stomach . Is this all normal ? At this point in my life I have never had health problems, so this is all kind of new to me. I am 68 years old.


    • Lois says:

      Hi Karen, I am also 68 years old and this too, is my first experience with kidney stones.I just had lithotripsy on Thurs the 4thof June. So far all that I can see in the strainer are white particles and am wondering if the same is for you. I,too, have lower back pain still.Yesterday, I felt nauseous and had some abdominal discomfort. I am wondering how you are doing, whether they got all of the stones. I have 2 or hopefully had!What about you, have you gone for your recheck yet?

    • Lois says:

      Hi Karen, I am also 68 years old and this too, is my first experience with kidney stones.I just had lithotripsy on Thurs the 4thof June. So far all that I can see in the strainer are white particles and am wondering if the same is for you. I,too, have lower back pain still.Yesterday, I felt nauseous and had some abdominal discomfort. I am wondering how you are doing, whether they got all of the stones. I have 2 or hopefully had!What about you, have you gone for your recheck yet?I have to have a CT scan next week and then my dr.visit. This has been one lousy journey.Let me know all about you.Lois

  15. Holly says:

    My blood pressure went up immediately after lithotripsy. It’s been over a month and it hasn’t improved. It was normal previously. I hear blood rushing in both ears. Maybe results would have been worse with a different procedure but I’ll never know.

    • Mike says:

      That is a side effect of the ESWL that doctors often miss to inform the patient. I am 35 years old and never had any heart related issues, without family history of High BP or such, but after lithotripsy, about 4-5 months later I was diagnosed with High BP and High heart rate, above 100 bpms. All the cardiologists where puzzled by this because all my heart checks were fine. After some time I got an appointment with a doc with PHD in cardiology. After he asked me about all my health issues from the past 2 years, when I got to the lithotripsy, he stopped me and told me that is the reason for my high BP. He gave me some pills that I have to take forever. If I would have been informed about this side effect of ESWL I would never have done it. The risk of getting high BP doesn’t worth.

  16. Mike Walker says:

    I had my shockwave treatment approx 6 months ago It broke up one stone but I still have one. I was in serious pain for several days and had to go to A&E several times. The treatment damaged my kidney causing it to bleed and swell it is now enlarged. I have had several CT scans and am awaiting final ones result and decision on what to do next. I have a constant pain in this kidney and take daily pain killers. The doctor says he cant do shockwave again and will have to use a laser to destroy the remaining stone. I wouldnt advise this treatment !

  17. David says:

    Just had the procedure on Friday after a very painful week of the 8mm lodged in my left side. Procedure went well and did feel relief immediately –first 24 hours post procedure were more about the groggy effects of general anesthesia and some soreness, Still have not passed any of the particles and last night the more intense pain re-emerged. Really hoping this is just a part of the healing process and this pain will pass today. I suppose the area where the stone was lodged remains tender for some time –at least hoping that is what is going on and not that another chunk is now lodged in the same place. Anyone else have intense pain post procedure that was in the same place pre-procedure?

    • Corey says:

      Hi David,

      I had the procedure on 4/21. I felt immediate relief as well. There was a bit of stone like pain the second day, but its gone. The most uncomfortable and slightly painful thing has been the stent. I am told I will have to keep it in till 5/7. On 5/6 I go in for another scan before stent removal. The doctor said there may be a possibility of larger stones that need another treatment. But in my case he said they were broken up pretty well.

      My stone was 9mm. It took a day before I saw fragments show up. I had stones before, but this one was six months of unknown off and on soreness. I had hip reconstruction in Jan, which I figured might solve the pain on my left side. Unfortunately it was still there and not hip related. After the lipotripsy I was able to walk with zero pain.

      Now I just count down the days till the stent removal!

      Hope all is working out for you.



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