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.

130 Responses to Shockwave lithotripsy (ESWL)

  1. 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

  2. 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.

  3. 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?

  4. Lois says:

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

  5. 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.
      John

  6. 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

  7. 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.

    Sincerely,
    Karen

    • 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

  8. 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.

  9. 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 !

  10. 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.

      Best,

      Corey

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