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.

67 Responses to Shockwave lithotripsy (ESWL)

  1. JB says:

    I had lithotripsy yesterday for 2 stones lodged in my right kidney. One was nearly 8mm which I think he completed blasted and the other—4 mm still remains. I wasn’t sent home with any pain medication but after about an hour of being home, I experienced the worst pain as if someone took a baseball bat and hit my side.
    It is more than 24 hours since I have gone and I’ve yet to pass one fragment. In addition, I’m feeling really terrible all around. Achy on the right side, cramp like in my lower abdomen and pain all around me–back and chest. I was wondering if anyone else has gone through this terrible feeling. I hurt all over my body and also have no appetite.

  2. thuzar says:

    My dad have had ESWL procedure but half of stone is still present. So doctor want to it again. I want to know is there any dangerous of repeating ESWL in one month.

  3. Jack says:

    I had ESWL procedure done two weeks ago but now the problems is the fragmented pieces are not passing out. Can someone tell me if there is a trick to pass out the stones, doc advised me to drink plenty of water and ‘Jump’ but another doc advised me to drink some beers as you will urine more to flush out the stones!

  4. Michelle Cappel says:

    I had treatment done three weeks ago for 5 stones varying in size. I still have mild pain coming from my kidney. I am wondering if this is normal. I have had more invasive surgery on a blocked stone a few years prior. They evaluated my stone and told me i was eating too much fish. Funny thing is I dont eat fish. I am 37 years old in good health eat well and just don’t understand. I have another 7 stones in my other kidney which I am supposed to have treatment done on.

  5. Himali says:

    My father who is 64 years had this surgery 8 days back, he was normal with a mild pain for 4 days, 5th day he had a severe pain , slight temp, and was taken to an A&E, prescribed antibiotics and a strong pain killer for 5 days and said his blood test is normal, now again he has a mild temperature with a slight pain, what should I do as his next appointment is in 3 weeks time. Now he complains of a slight burning feeling when passing urine after 8 days!!!

  6. Kiran says:

    Hi, I have a 6mm Stone in upper pole of right kidney. Dr suggested me for ESWL.
    As I see on net it is painless procedure compared to other treatments.

    But I would like to know if Stent placement is mandatory for 6mm stone? Otherwise is that OK if I ask my Dr to perform the procedure without stent? Please suggest how important is it to have stent?


    • John connor says:

      I just had the treatment yesterday no stent was needed for a 6mm stone.I had a lot of blood in my first urination and was taking tylenol every 6 hours afterwards .I am using a urine strainer to catch the fragments from the procedure.I have to follow up with my urologist in 3 weeks time.

  7. Tom Lombard says:

    I am 68 with a previous history of 6 kidney stone episodes. Had first ESWL yesterday for 15.5 mm stone in right kidney. Very little pain from shock or stent. No pain meds needed so far. Bloody urine for 24 hours but lessening. Caught a couple fragments in filter but we’ll see next week if the whole stone was smashed. Three years ago I had 17 mm stone removed by percutaneous surgery and that was a miserable experience, making ESWL far more preferable–so far.

  8. Stephen says:

    I am a 50 yr old male and was found to have a 18mm staghorn stone in the lower pole of my left kidney right over the duct. I am getting the stent put in with the ESWL procedure. I was told that it may take a couple ESWL treatments and they are going to leave the stent in. Personally, I’d rather have it surgically removed and take my chances with infection but my Dr won’t hear of it. This is scheduled in 6 days. What is the physical limit of the ESWL procedure? I want to tell him to just beat the heck out of it so an additional procedure won’t be necessary. Do I have the right to refuse this treatment and only opt for surgical removal? Please advise. Thanks.

  9. Vivek says:

    I have 22 mm stone in pelvic junction of right kidney. Can i go for eswl ?

    • Dr. Mike Nguyen says:

      A stone that size is considered large and can be treated with ESWL but be aware that more than one treatment may be needed (about half of stones 2-3cm required at least two treatments). Additionally, most urologists will leave a stent when treating large stones with ESWL.

  10. Susan B says:

    I had multiple stones (obstructing, on both sides) and ESWL was needed, but I had to wait two weeks as I had been taking ibuprofen. Was quite frightened about having the procedure based on what I had read on the internet. Procedure itself was entirely painless (I was awake but sedated). Blood in urine that day, and passed many stone fragments over next week. Recovery was completely pain free (although my bladder felt irritated ), and it was back at work the next day. Truly, I wish I had known that this would honestly be no big deal! Best of luck if you are scheduled for this, and honestly, relax.

  11. Nancy says:

    I was just told by a urologist that because of location and size of stone I need this treatment. He made it sound very casual and non invasive. However after reading things on this and other sites, I am concerned. Dr never said anything about possibility it may not work, or about pain and side effects afterwards. Any suggestions???

  12. Anita says:

    I had this done November 20th. The procedure wasn’t bad. I was fully knocked out. I was very sore for about a week. My throat is still sore! The pain seemed to be better. The stone was 6mm an they said is shattered well. Well yesterday I woke up in pain. An it’s worse today. I doubled up on my pain meds in desperation. But I’m still hurting. The stone was in my left kidney. The pain I’m in now is a shooting pain in my back on my left side ( where my kidney is ) when I first came home from surgery I peed blood twice. Which is normal. An they send you home with a strainer to pee in an a cup. I only passed a few crumbs of it. There was a little sand like stuff upon the strainer. Has anyone else had this happen to them?

  13. Tom says:

    I had ESWLyesterday for 3 stones bunched together is left ureter. 8mm X 13mm long. This is the second time I have had this procedure as the first time was about 7 yrs ago. This was much better. I felt good the evening of the procedure and feel back to normal today. No more pain from stones nor from the procedure. It really depends on the technologist, the doctor and anesthesiologist as to the your results including the location and type of stones. I believe that is why there are so many different results noted here and other websites.

  14. Barbara says:

    lol u cnt do anythign after this procedure it is the worst thing ever.. they gav eme sedation it didnt work.. shit job lol .. ive got 0.9mm i had lithotripsy for 10 mins it made me unwell for 2 weeks discusting.dont do it

  15. Em says:

    I had this procedure done three weeks ago and it did wonders. I had a 7mm stone and I basically had to do it. I was sore for almost a week after but since the stone was blasted into sand it all passed that day. I’ve had many stones and this was the first one I had treatment on. Pretty crazy considering I’m in my 20s, vegan, and active.

    Regardless, if you have insurance I recommend it.

  16. ruthy says:

    I had a ESWL surgery 2 days ago , and I’m in strong pain ,I was drinking a lot of water but I noticed the low urine flow….I have constipation pain in my hips like befor to deliver a baby…. vomiting…. I’m taking vicodin for handle the pain.. somebody can tellme if is normal ? I cll the doctor but I can’t rich him….please

    • Em says:

      After I had it done my bladder was in the worst pain ever. I took pain pills every 3 hours and about 3 days later it was fine. It may be the medications that are making you sick, that’s what made me sick. The procedure just made me sore.

  17. tari hafner says:

    I am supposed to get ESWL, not scheduled yet and I def need a second opinion which will get before going through with this. My urologist actually wants to remove my right kidney because it is deformed and very small. A scan shows it functioning at about 30% but he doesn’t believe the test results. A different dr feels I should not allow my kidney to be removed until I try getting rid of the stones which may or may not be causing repeated bladder infections. The urologist said he will be surprised if ESWL will help me but he will do it as soon as he can schedule it. I now read that a deformed kidney should not have the procedure and I wonder if I should do it at all. I guess I just really need that second opinion and a lot more information. I am not ready too have a kidney just removed when no doctors can tell me if this will solve my problem either. I think they want to do t to prevent another kidney infection which they feel can kill me. I am 62 and have had 2 kidney infections in my life, the first when was 6 and the second a couple years ago. I am so confused about whether or not to allow this procedure on a small and deformed kidney to remove stones.

  18. Kayla says:

    I don’t think you will feel like riding a mountain bike the day after lithotripsy. LOL.

  19. Joey says:

    I’m scheduled to have ESWL done this weekend. What are the risks and how will it be avoided. Is the damage to kidney tissue inevitable or it depends on the skill of the doctor? Any permanent side effects? I’m a weekend biker too,, can a ride my mountain bike day after my procedure? Thanks.

    • JK says:

      Not a chance. You will bounce back quickly but the following two to three days should be cautionary. Expect the best, plan for the worst. It is quite uncomfortable, the medications will likely make you feel ill and when you start passing the stone fragments it could be bad. None of it lasts long though. Go biking the next weekend :)

      • Teen2 says:

        I have a 5 mm stone that does not show on X-ray only on ct scan and ultrasound. As a result my doctor might not be able to do eswl but will try prior to ureteroscopy. Any chance of it being more visible at that time?

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