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.

104 Responses to Shockwave lithotripsy (ESWL)

  1. rob says:

    I had a lithotripsy procedure for a 10mm stone that was also dense 13.87 …my urologist got the entire stone bless him…it took 8.1 days for me to feel normal….just like the average..my first night was painful because of trauma around the area and I had no pills till the morning (I hadn’t picked them up in time because up until closing time at the pharmacy I felt no pain). The combination of the anesthesia and the pain pills (which I only took for 1 whole day) gave me bad constipation but the doc suggested Miralax and 2 days later I was (almost) good as new. I would recommend this procedure rather than invasive…I do realize I was also lucky because the dense stone could have formed fragmented stones which would have hurt like hell when passing…

  2. Jesi says:

    Just had my first treatment done earlier today. I was put under General anesthesia. Before that though I was wheeled into the room and asked to slide over to the machine bed. Then part of the bed was removed under my left side and I was asked to move up or left to adjust myself for the procedure. An oxygen mask was put over my mouth and nose and I was told to breath deeply, but I was having difficulty catching my breath. I had been given medicine to calm my nerves before the procedure, which made me pass out and snore loudly lol. After that I was given my meds and slept peacefully for the duration. I was fitted with a stent before the procedure, as my Dr had informed me. I woke up much later very groggy with a severely sore throat from being intubated. I also felt the urge to pee but wasn’t able to get up and go. I also had the embarrassment of being on my period during this procedure. I wasn’t required to urinate before leaving. I threw up from the smell of the anesthesia or whatever I had. They wheeled me out to my car where my husband and two of my kids waited. I was given prescriptions for a bladder spasm medication and Norco for pain. I proceeded to puke again in the car. Twice. I went home and slept for several hours. Then I had to urinate. It wasn’t so bad the first time. But every time afterwards has been hell. Like razor blades. I’m using a strainer and finding tiny bits of kidney stone. Like sand. Drinking a ton of water because it hurts less if I go with more than less. Probably bleeding but can’t tell because of my feminine issue lol. My stone was 20mm by 20mm by 7mm in my kidney. I go back next week for an x-ray or ct scan to see what’s left and if another treatment is necessary. And maybe stent removal but I doubt it. I feel great. Like I can do anything but know I shouldn’t. Hope my experience helps someone else.

  3. Beth Proctor says:

    I have had two already but may need a third. I’m worried because i don’t know how many are safe. I’m a parent of 4 amazing children and don’t have a sitter most of the time. And i feel very guilty if i have to leave them any where. I’m worried that there is a limit amount of them you can have, i don’t want to have any permanent problems to where i can’t take care of my babies. I am in pain again and know that i will need it.

    • Mike Walker says:

      Sorry to hear of your concerns. Have you looked into lazer treatment my son in law had it done with no after care problems. Good Luck
      Mike
      UK.

  4. Mike Walker says:

    October 22 2014.
    I have just been told by my consultant that the lithotripsey caused a bleed around my right kidney. He says this happens rarely but is recognised. I now have to go for a more detailed CT scan to decide how to proceed. Since the treatment apart from the pain I have to get up 3 or 4 times a night to empty my bladder. It has made my life miserable. Dont have this treatment its a quick fix for the medical proffesion but not for the patient!

  5. Arn says:

    4mm Stone inside kidney with no pain. Do surgery? OR Don’t fix it unless a problem?

    Any opinions or suggestions based on your experience or expertise?
    I am told i have a 4mm non-obstructive stone in the inferior lobe. This 4mm was found today. 3 Days back i was rushed to emergency and they found a 3mm stone close to bladder (my first one). I passed the 3mm (no pain now) and i think it should have passed out. During my consultation with urologist, he said there is another 4mm in the kidney that was not found during my emergency. The urologist says i must take a non-invasive surgery. I am a bit concerned and need more input before i decide. Thanks much.

    • Mike Walker says:

      I would avoid shockwave treatment. I had terrible pain for over a week and had to go to A/E 4 times. I developed infections. It has also caused piles to come down and bleed. I would opt for a surgical removal. I have researched and found studies that show an increase of risk x4 to develope diabetes and hypertension.
      Good Luck
      Mike

  6. Matt Ryan says:

    I had a 3-4MM stone pass from my kidney to my ureter on aug 13, it never passed. Since then I have been having a throbbing in the left testicle and penis. It comes and goes and the pain is tolerable but sometimes its worse. CY scan shows stone is about and inch from my bladder. I have a uteroscopy scheduled for Oct 2nd. They are putting in a stint as well after they remove the stone. I have only had one other occasion of kidney stones about 12 years ago ad I passed that one in the ER during a urine sample. From all that I have rad here I am hoping not to have any adverse reactions post op. If anyone ahs any helpful info please post, thanks…Matt

  7. Mike Walker says:

    I had my third treatment on 9.9.14 . The previous had partly broken the stone. On this treatment they increased the power. The stone shattered it was 12mm. Later that day I couldnt move for the pain. I was sick and fainted. I felt as though I had been kicked in the side. I had to take tramadol plus cocodamol also diclofenic suppositories. I had to go to A/E they said I had developed an infection and gave me antibiotics.. I have been ill since then and have had to return to AE twice. I am still passing bits of stone this has also caused severe diahorea. I WOULD NOT RECOMEND THIS TREATMENT TO ANYONE. On research several institututes have found it increases the risk of Diabetes and Hypertension.

  8. mary says:

    I live in UK. I had SWL 4 days ago, to blast a 6mm stone.I had no pain meds beforehand, just a mild sedative towards the end as the pain go too much, I was ok for 2 days after, then the 3rd day was in agony….and the 4th days ( yesterday ) had to go to A and E dept….they gave painkillers via arse cheek injection and anti emetics. The relief was amazing. Does anyone know if the pain has stopped because the stone and its fragments have moved form the ureta. I have drank a lot of water and peed loads, but have not felt any pain when peeing. Has the dreaded stone gone or is it waiting for me to relax again before another nauseating attack?

  9. Emily says:

    I’ve had 2 stones.
    The first was a 2cm (yes, CM) stone in my left ureter. I went in for ESWL. It only took care of 10% of the stone (so 2mm – there was still 1.8 cm to go). So I had to have the ureteroscopy with laser lithotripsy anyway. My MD told me he needed to use the highest powered laser to break it up. Had a stent for a few days.

    The second was an 8mm stone in the left ureter. Went straight for the ureteroscopy. When the MD went in, the stone wasn’t there, but there was trauma and infection, so he put in a stent. That sucker had retreated into my kidney, then came back down and started pushing on the stent. Worst pain of my life. Couldn’t walk. Couldn’t even clean myself after using the bathroom. Wound up in the hospital for 3 days (at the height of the worst flu pandemic in a generation in my area). Had ESWL done on it. I think it broke the stone up enough to let urine flow, but not enough to pass. But it doesn’t hurt anymore.

    Now, I think I have a stone in my right ureter. I’m going to a different urologist (I don’t want the pain of the stone against the stent again…do it right the first time and take xrays!) Wish me luck.

    • God luv you!! i am currently incubating two stones. a 12mmx10mm in kidney and a 10mmx25mm in ureter, every time i pee i want to vomit with the pain! GP as prescibed oramorph. The stent is the worse pain ever(i have previously had four stents fitted) really am at the end of the British stiff upper lip

  10. Marsha says:

    Had hardly any pain after Stent and Shockwave to break up a 1.4 CM stone. Has not a problem for me at all.

  11. kerrie says:

    Everyone please listen up. I did my research before going to have my lithotripsy. I told the doctor that I did not want to receive more than 60 shock waves per minute. This was because all of the latest research has repeatedly shown that all of the side effect dangers of long term renal damage as a result of lithotripsy could be reduced to 0.01 % chance as long as the rate of shocks per minute did not exceed 60. It also stated that our urologists are already aware that they should pause for 3 minutes between administration of each set of 60 shocks per minute and that the total number of shocks required should not exceed 1000 – 1500. The less shocks required the better the long term outcome. All of the research also indicated that most doctors/clinics did not like to even acknowledge the latest evidence of better treatment protocols. This is because the pause of 3 min between each set of 30-60 shocks caused them to go much slower resulting in getting fewer patients pumped thru for treatment per day. That means less revenue per day and less total revenue per year. So I was ready for my doctor to push back before ever presenting my findings.
    Sure enough, right off the bat I was cut short and told that the research was not accurate and he acted as if I was talking from unreliable or legit sources. Luckily I had all of the information and websites pulled up on my mobile device. I showed him that it was from studies done by top U.S. urologists and the website was the same one that doctors refer back to when they have questions. He then took it and looked down starring at it and then literally stated that he didnt recognize or had never seen or heard of the website. The website he was looking at was the US National Library of Medicine and National Institute of Health’s website. Every doctor not only knows of the website, but refer to it on a frequent basis. So I knew that getting him to adhere to my preferences, based on my freedom and human right, was going to be a difficult challenge.
    He realized my persistence and agreed to perform the procedure as I requested. I told my nurse that I would like to have the localized numbing so that I could remain awake. I was told that nobody ever stayed awake during lithotripsy and that it wasnt even possible. Then I later learned that was a blatant lie when a nurse at my regular physician’s office told me that she was awake during her lithotripsy procedure.
    The machine malfunctioned during my procedure and the doctor came out and informed my family that it had “just stopped working and they did not know why”.
    Not only do I fear that he just agreed and lied to my face about doing as I had preferred, but I also wonder what really went on. How many shocks per minute did I really receive to my kidney that day? How many shocks total were there? Did he really pause for three minutes between administration of each set of shocks? Why did they lie to me and insist I be out completely? What really happened to cause the machine to just stop working? Did it malfunction and cause serious damage to be done to my kidney? H
    Also, I suffer from ulcerative colitis which means that most anti biotics can trigger a flare. I explained my concern to the doctor and out of all of the anti biotics he could prescribe, he chose to prescribe cephalexin which is to have a known side effect of causing C. diff. a deadly bacteria that forms in the intestines.
    Do your research. Check out the link to the truth regarding longterm safety and protection of your kidney and lithotripsy. Ask to be awake and ask for proof of how many shocks you get per minute and total number of shocks from the whole treatment. Make sure they do not give you more than 60 per minute and that they pause for three minutes between sets. It is also better if they start at 30 per minute and each set go up a step. Like 30 per min for the first set, then 40 per min for the second set, and 60 there after for the rest of the sets.
    Not only does it make the percent of damage to your kidney and other organs go down to almost zero, but the lower shock wave per minute was also proven to cause better breakdown of the stone. The fragmentation of the stones were way better than they were at higher shocks per minute. Also, the larger the shock zone, the better the results and less shocks required. This was because when we inhale and exhale our bodies move and therefore they found that the target or stone would move out of the shock zone. This meant that far more shocks had to be administered to your kidney just to do the same job. I just hope that this information gets spread to more patients, because even though the doctors are being informed from their own medical community they are not listening and adhering. Fast, careless work making as much money as possible will always outweigh the longterm risks to patients. It wont change until enough patients and regular people know the same thing that their doctors already know. Good luck everyone.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923385/

    • kiran says:

      I am little scared of your comments. Do you recommend me to go for ESWL? I have 7mm stone and doctor is recommending that.

      • Rodney says:

        I have had 3 Litho treatments and would recommend to anyone with stones. The discomfort from the treatment for me was so much less painful than trying to pass the stone. I want say that there was no discomfort but I was able to tolerate.

  12. Olivia Wilson says:

    My husband had Eswl and is in serious pain. His stone was 3.4 How long will this last

  13. muhammad ali says:

    I have .17 mm stone and it did not break up today after my SWL for half n hour’ doctor said what r u eating cement lol its been more than 14 hours m feling pain in my kidney I hope after 15 days they break this bastard down….
    there was a guy who had 2 cm in left and 1 cm in right kidney and his stones broke easily’ any ways guys b relax it hurt a little but u live.

  14. nancy says:

    My husband had eswl 5 days ago. Excruciating pain for the two days after procedure. Almost back to normal but still a little sore.

  15. Kendall says:

    I had lipotripsy 4 wks ago.but my kidney still has a dall pain.how long does the pain last?

  16. Al says:

    Can a ESWL break up a stone that is 1.2 cm and if so how long will it take for the pieces to pass?

  17. David Jamieson says:

    I’ve just had this treatment for a 7mm kidney stone. Doctors were not sure if this would work for me as the stone was quite large. It’s not a pleasant process to start with but you soon get used to the unusual sensation . It worked for me and feel fine after five days. I would recommend it.

    • Mary says:

      A 7mm you are a stud. That had to hurt like crap. God Bless you. I had a 6mm that would not pass had to go to emergency surgery they finally got it removed. All this on top of a kidney infection and I went into sepsis and septic shock. I am lucky to be alive. That was a year ago and since I have been blasted twice. I guess I am a stoner. Thank God. Don’t ever mess with your kidneys.

      • larz says:

        I am having this procedure tuesday am. I have a 14mm stone in my left kidney and over 4 cm worth (collectively) in my right. My right will be a separate operation in September. No sounds waves for that one. :(

        I have had a stent in for a month as an infection caused me to almost go into septic shock – ended up in ER and they found these !!! I had to stay overnight and get the stent put in along with IV antibiotics etc.

        I pray this procedure gets me going on my road to recovery and to be stone free one day. baby steps. Hope the pain afterwards is not too much to bear. I tell ya, life can go from one thing to another so quickly. Wish me luck !

  18. Ivory Carter says:

    I had ESWL on March 21st and then I had it again on May 16th my right kidney feels much better but I’m still having pain in my left kidney

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