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 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.
Closeup view of ESWL machine treatment head.
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.
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.
im just curious..after eswl..what tube is left inside the penis??the stent shown above is left inside for a month?
They don’t give everyone that. I didn’t have one
I had my a procedure in mid-dec last year to deal with a vessel that was blocking the junction of my ureter and right kidney. The doctor cleared cut that vessel and put a stent in my urinary track as my kidney was dilated due to the blockage. I also had a history of kidney stone of 1cm for six years. After a month I had my first UTI, went to emergency and my stent was replaced as it was infected. Took medication for a week and on last day of medication i had my second UTI. Again went to emergency and end up in hospital for 4 days. After that I had to take IV medication for 10 days. After a period of three weeks had my first ESWL procedure, Dr. checked x-ray and suggested I need second ESWL procedure as the fragments are not small enough to pass. had my second ESWL after two weeks and this time, it was a success. Dr. finally removed my stent which stayed in my body for 5 months. I have passed considerable amount of small stones, some were like sand.
My concern is, after a month of my last ESWL procedure, along with small stones I feel white powder coming with the urine especially when i am done, few drops of diluted, powdery urine.Is it normal or it is something I should consult my Dr. about? I sometimes feel a mild pain too in my right kidney and sometime a very sharp pain in my ureter especially near the bladder which lasts for few seconds only. Is this normal or not?
I had EWSL performed one week ago on a 7mm stone in my upper ureter. The doctor said he was able to break up the stone and has instructed me to see him in three weeks during which time I am to drink lots of water and take Flomax. I am continuing to experience mild pain now in my lower ureter and I have seen no stone fragments in my urine. The pain I now experience is nothing like before, and using three OTC Ibuproffen tablets knocks the pain right out. Most of my discomfort is at night while trying to sleep. Is this common? Could it take stone fragments this long to pass?
Did you have your follow up KUB? The stones could be lined up in your ureter (steinstrause) not moving. They may be too large to pass and may require another lithotripsy treatment or holmium laser. Do you have a ureteral stent? Make sure you follow up with your doctor and get the KUB X-ray. It takes stone fragments time to pass.
What is flomax? I wasn’t given that
I’m due to have lithotripsy later this week.
I’m curious to know what other people think of the continued exposure during the procedure to the x-ray machine (the flouroscope). Can’t seem to find a huge amount on the risks/side effects around this, and I’m a bit concerned at having continued x-ray exposure during a 30 min+ procedure.
Any comments/advice etc welcome
Rgds
R1ch
Rich,
X-rays are only used periodically during shockwave lithotripsy to check on the positioning of the shockwave head and to check on the progress of the procedure. They are pulsed on for a few seconds at a time to get a “snapshot” – they are not used continuously during the entire procedure. So even though the procedure may last for 30 minutes, the amount of time that fluoroscopy is actually used is usually much shorter. A study from Greece found that the average amount of fluoroscopy time during their ESWL procedures was about 3 and a half minutes (204 seconds).
A link to the study abstract is here:
http://www-ncbi-nlm-nih-gov.libproxy.usc.edu/pubmed/16691107
The flouro is not continuous during the procedure- only intermittent to check position of the stone in the F2 focus ( where the shock wave is being directed at the stone) flouro time is minimal, and is a coned down area of your kidney only.
I’ve had a 4mm kidney stone for over ten years and last Friday it decided to let me know it wanted to move out. I went to the emergency room twice for pain and pressure in my back and groin region. I saw my urologist the day after Memorial Day and he recommended the lithotripsy procedure. I had the procedure done yesterday (Thursday) and it went great. I was still under the awesome drugs to feel any pain the night of but the next day was just filled with mild-medium soreness. The stone fragments where so tiny that a strainer wasn’t even required. I will admit the first time i saw blood in my urine I almost passed out. I thought the procedure was ideal for me despite the cost and would do it again if I was able to. I’m really glad I didn’t need a stent after all of the readings I’ve done.
[…] Shockwave lithotripsy (ESWL) […]
its my husband who has been undergoing ESWL for four times already, and is planning to have another session for his left kidney this coming June. My concerns are:
1) how safe it is to have repeated GAs that goes with every ESWL? what complications will it result into later on?
2) is there a great possibility for complications on diabetes or in other forms of diseases to develop later on?
3) my husband is already taking medications for diabetes now, is there any chance that this disease will not “bloom” so as to lead to kidney cancer in the future?
thanks, Mary
I have had ESWL treatment for my rt renal kidney year back and it was success, but then after few month i found again a small 3mm stones in same place, dr’s saying its normal and will pass off. But now i have had again 4 mm and 10mm stone in same kidney, what to do is the same process ESWL can do again ? what will be its side effect? or what else the procedure for my kidney stone.
After several weeks of pain and unsuccessful tests, an ultrasound showed my R ureter to be inflamed, and a CT scan showed what appeared to be a 6mm stone at the juncture of my ureter and R kidney. I had ESWL on April 15. I strained my urine for several days, and did not see fragments. My symptoms remained the same – feeling like a small tree brach was vertically inserted into me from the bottom up on the right side.
Since the procedure, it is only slightly easier to sit. But now I still have pain and abdominal-area bloating, causing much lower-hemisphere tension that now coincides with constipation and chronic bloating. I am also now getting random shooting pains directed north and south of where the stone “used to” be.* Sometimes the shooting pains travel at a more horizontal or diagonal angle, across my groin to the other side. I have also been experiencing waves of nausea and general stomach upset, but there is a possibility this is related to something else.
*The urologist showed me the follow up CT scan today, and there was no evidence of a stone in the location it had previously been.
>>Is it possible, that after about a month, I might still be dealing with small fragments located somewhere in my ureter? Perhaps they are too small to be captured by the CT scan? My urologist didn’t know what to say about my continued and new symptoms, and referred me to gastroenterologist. The bloating makes me look like I am pregnant, and it is constant. I am starting to see one small black “thing” each time I pass urine. Is that what I have been waiting for?
I had an 10 mm stone in the ureter just outside the kidney and 2 very small stones in the kidney. Had lithotripsy and a stent placed on 4/17/13. This procedure obliterated all the stones, had some blood for a few days and incredible pain from the stent. The trick is with the stent not to move around. My dr. gave me permission to remove the stent at home after 24 hrs. due to extreme pain. I have been fine ever since. If you have no insurance (as we didn’t) I highly recommend Surgery Center of Oklahoma. They did it for a fraction of the cost of any hospital or kidney stone facility I called. We traveled from Tx. to Ok. in one day had the consult and procedure that afternoon and was home that night. The staff was professional and even called me the next day! I’ve had stones over a 20 yr. period and I highly recommend them!
My husband has a 4×9 mm stone very close to bladder but won’t pass. His Dr wants to do a laser ureterscopy but we don’t have insurance. We already have a $11,500 hospital bill for the 1st stent insertion. Does thr oklahoma surgery center do laser? Is it worth a trip from TX?
I am scheduled for shockwave lithotripsy in about a few weeks. The stone in question was diagnosed four years ago or so in my left kidney. I also had another stone in my right kidney at the same time that passed–horrible pain, the worst, until it fell into my bladder and then no pain at all. I developed these two stones after being told to take 1000mg of calcium/vitamin D supplements. Never had stones in my life. I stopped the supplements right after. I only take a multivitamin now. At the time the stone in my left kidney was measured at less than 5mm. I went to my urologist every six months or so for checkups and then I stopped a couple of years of years ago because the stone was causing no symptoms and not moving. I had no trouble from it until several weeks ago when I started experiencing throbbing pain like a mild backache that was taken away with two advil every few hours. I saw my urologist a couple of weeks ago, had a cat scan and x-ray taken (stone hunt) without contrast and the stone has apparently moved and grown. I am no longer in any pain. But the stone is now at the end of my kidney by the entrance to the urethra. It has grown to 7mm. I was told by my doctor that there is no way I will be able to pass a stone this size (although I’ve read posts here from people who have passed larger stones than this…) She also said the size was perfect for the shockwave lithotripsy. My doctor says there is a slight swelling of my kidney and a slight blockage because of this and while she doesn’t recommend that I wait too long she wants to do the lithotripsy and says it’s the least invasive procedure and only 2% of patients have to repeat the procedure. I have no trouble urinating and my urine is clear (although I have microscopic blood in my urine when analyzed). I am writing to ask, is there a way to do the shockwave lithotripsy without being IV sedated (she said it was the same sedation as used in a colonoscopy.). I am afraid of being put out….I asked if I could have an epidural instead, like I did when I gave birth, she said the kidneys sit too high up and it can affect your breathing….Is there something else that would work besides being put out…Is the procedure painful??? My blood pressure is low normal. I also don’t want to develop high blood pressure and/or diabetes later in life from this procedure….Sorry for the long winded story….any advice would be welcome….
It is important to have anesthesia so you don’t move during the procedure. The focal point is very small so only the stone is absorbing the shock waves, allowing the stone to break. Success for the procedure depends on no patient movement and shallow breathing.
My 1 st eswl was 18mm with high fever infection. Hospitalized 3 days before for antibiotics and 3 days after for a lot of blood in urine. Had bruising and a lot of pain meds for about 1 week. Then just tylenol. Stones large prickly grey ones finally began coming out 9 weeks later. Nothing like sand. The urologist had said he blasted them all, and they just exploded. The stones came out for 2 1/2 months but didn’t really hurt very much. All was well for 9 months and the old familiar pain returned. For six months I was in complete disabling pain. I had 2 2mm stones pass in Dec, but still couldn’t get an appropriate referral. 3 months later finally a urology Appt. I now had a 10mm in the same spot and also a 7 and a 5. The Dr conjectured it possibly wasn’t all gone inthe first place. Pain meds weren’t doing much but putting me to sleep, but a combo of ibu and Tylenol worked enough to be able to walk. Litho was outpatient , no bruising and by next day it was amazing I could bend, walk sleep without vomiting I was thrilled. Dr said the stones just exploded and he was confident he got them all. I also had a stent and a lot of blood in my urine. After 5 days still blood, passed a few sand like stones, and began to hurt again. Was given Flowmax, took it faithfully, now 12 days later, a lot.of pain in lower back, and bladder and urethra and larger stones are passing. I had Xray today, 3 stones in kidney, one in bladder visible on simple Xray. Lots of blood and pain in urinating. Darn it was so good. I see the Dr again on the 15th. I was only able to stay moving about for 3 hours today. I am trying the vicodan to sleep tonight.
I live in Bon Air Va (outside of Richmond) and we are blessed with wonderful urologists and facilities here for treating all types of kidney/bladder issues. Had stent put in 2 weeks ago and a lithotripsy (sp) yesterday. Successful in shocking the smaller stone, but the larger one is lodged in the kidney that does not enable shocking at this time. I have leukemia and it is imperative that the larger stone be broken up near the ureter so it will not leave granules in the kidney to get infected. Cannot say enough about my Dr. Kramolosky…..the teamwork is excellent at Va Urology and they walk you through the process. This is a great website also.
I was so lucky to join the lithotripsy club on Friday 🙁 while I was fortunate enough mine only took 20 minutes, I definitely don’t want to ever go through this again.
I had my third litho sugery today. My question is: how many of more of these procedures can I have before it starts doing damage to my kidneys and health?
All surgeries were both kidneys, aprox. 25 stones each time and all about 3 years apart.
I had lipotripsy done on a 10 mm stone with a stent put in afterward to keep any oversized fragments from causing blockage. 18 days later an X ray reveals on a follow up appoinment to remove stent what looks to be 3 fragments approx. 3 mm or more in size. The follow up was to remove the stent. The X ray was to verify no fragments were too large to pass and thus abort removing stent. These fragments are too large and another lipotripsy will need to be done.
Can anyone answer the folowing question?
Question: If the doctor can see the stone during the lipotripsy procedure to place the cross hairs on target for each shock wave blast, then why don’t we know at the end of the procedure right then how many fragments there are and how big they are?
See my point?………… It was not known if there were any fragments and what size they were by the Doctor who did the procedure until the X ray showed this 18 days later.
Is there some sort of end of procedure condition that prevents being able to see the final resulting fragments?
If you can reply to this then you have been gifted with knowing some rare information.
No seems to be able to answer these questions.
Please respond. thank you John DW
There a few potential reasons why your doctor may not be sure at the time of your ESWL procedure whether a second treatment may be necessary:
1) Stones, even if successfully broken up by ESWL sometimes do not disperse immediately. The fragments may instead stay all clumped together. On an X-ray this would still like a single intact stone. Over time, the fragments may separate and pass down the ureter. Your doctor waits to check an x-ray a few weeks later to allow time for this process to happen.
2) Some stones, while visible enough to target and treat, are still hard to see on an x-ray clearly at the time of surgery. This makes it difficult to know for sure whether the treatment was successful. The X-ray taken in the radiology department a few weeks later is often of higher quality because it is performed on dedicated equipment.
The best case scenario is when an easily visible stone is “pulverized” on x-ray. In these cases, your urologist can confidently tell you that your ESWL stone treatment was successful.
HELP! I feel like I’m all alone in this kidney related stuff.
First of all back in Aug.2012 I had blood in my urine and I just wasn’t feeling to good as well. Got a urine test and results showed a urine infection, per the phone call I rec’d from nurse. A Rx. for a sulfur type of drug was given to me, I believe. A follow-up urine collection was done and I showed no signs of infection. Not even a week went by and dito to the above. Once again the collection showed a infection in the urine. This time I was given a different antobiotic. Not K-Flex because along time ago I took it and ended up with suto membrane colitis. Cipro was the Rx. for the 2nd infection. My primary requested that a US be done for my abdomen (kidneys and bladder) and a cytology ? specimen to check for cancer cell bacteria. (None present) Slowly, ( and that’s an understatement due to delayed approvals)
I eventually saw the urolgist. Yea! Well….I hoped for a very positive experience and I’ll be nice and give him a 6, NO a 5. He requested a Urogram CT with and with contrast and some more blood work including CBC, Red and White cells and etc. And….he requsitioned a Cyscoptophy. (Camera within to look at kidney, bladder and pelvic area. O.K. it’s now Nov. all the above are done and I’m told that I have a kidney stone in ? A particular x-ray would determine where it was? So…I had that done to. Oh….and in the middle of this or I should say end of this l was told that a Litroscophy (ESWL) on right side would blast that little puppy to pieces.
It’s now Fri. 12/21/12. Well….ESWL went, well…. I guess how it was suppose to……….! I came home with a RX. for Fomax and a stool softerner. Got home at about 4:30 p.m. my husband helped to get me settled. And…then he left for Rx’s. Well….all of a sudden I felt stabbing like pains in my pelvic area and horrible pain in my back like arrows were being shot thru. (Oh….I forgot to tell you I’m a post anterior/exterior inter-body fusion pt. at the L5-S! area.) I called the dr. on call and he said to double the tramadol and to take 2 of the Fomax. Helped some….at least I wasn’t screaming but…..in loads of pain. So…Sat., and Sun. goes by with me bareley holding on. Now on Mon. Yep…just two days ago and the day before Christmas Eve. and the Dr. calls to check on me. What a surprise! I told him of all my above news and he said to come in the see the nurse prac. O.K. so off I go….vitals checked and etc. (Like blood in urine) Had me stop taking Fo-Max and start taking Norco 5-325 mg. every 4 hrs. And….that I did from early Eve on Monday the 23 of Dec. thru 26th of Dec. until I called the Dr’s office this a.m. to advise them I was having to much pain on the rt. side in the pelvic area and it went straight thru to my back and………it was horrible to deal with. Asked if they could give me something else. o.k. but before he did that I was off to urgent care 15 miles away. And….it looked like an army of people who were quite sick. A 2 hour wait just to see UC Dr. After 3 hours I was told that they could do nothing more..they did some blood work and a CT. All they saw was a couple of small stones in the right kidney that had not passed. Told me to double up on Norco. every 4 hours and ride it all out. I hope I won’t become an addict by then since the pharmacist told my husband that I should just take as needed since it’s very addictive. I’m not happy about all this. I don’t feel like I signed up for all this drama or pain or complications. Actually, the hardest part is when the Dr. said, what….why do you have pain in the pelvic area, or when he said this morning, you shouldn’t have any pain by now…..4 1/2 days later. But….I’ve read online here and other places that alot of people have pain after the ESWL. Oh…and by the way this medical group is pretty well known as a teaching hsp and university. If you want…..my opinion they are too…………big for their britches. What should I do? Oh…yea….starting on the 1st of Jan. 2013 I have a new group and new provider. Oh my! God….help me…literally! Just venting and Thanks for listening….no judgement please. I’ve done the best I can do with the tools that I’ve had to work with. Looking forward to pats on the back for long….suffering. 4 + months. Hope you all had a MERRY Christmas.
Thank you so much for sharing. I have been feeling so frustrated lately with this issue myself. I have undergone two lithotripsy in the past 2 years and I have been told by my doctor that because of the high radiation that is all that one person can have in a life time, therefore any future episodes would require passing of the stone or an actual cut to the area in order to remove the stone. I went into the emergency room one day with massive pain to my right flank like a 10+ and they immediately ordered labs, x rays, CT scan, you name it. I was admitted and underwent a procedure. The doctors decided to help my stone along by maneuvering the camera to manipulate the stone along the kidney path and push it alone the way, However,- GUESS WHAT? YES!!! he punctured my kidney because the camera went and did it’s own thing. NOW, -after that horrific procedure I was on a catheter for one week and received antibiotics, Pain medication and doctor Ridiculous visits over the next several months. I’m always in pain and my urologist dropped my care because of my complaint against him and his colleagues. I give up! I started to think it was all just me until I came across your posting. Thank You for sharing.
i have two large calcium stones in the left kidney. i have had two litro procedures with stunts with no success. how i i get these stone to brake and pass
I had my first ESWL this morning. I had an 0.9mm stone in my right kidney
The procedure went great. I am sore but nothing horrible. So far I am just passing what looks like sand. I do not have any stents in. Good luck to everyone having this procedure.
but sorry to say I do not seen the stone came out. please answer me.
I had my first ESWL this morning. I had an 8mm stone in my right kidney
The procedure went great. I am sore but nothing horrible. So far I am just passing what looks like sand. I do not have any stents in. Good luck to everyone having this procedure.
I had undergone the ESWL on Monday morning and at night apprx.11:00 pm, the broken stone came out with little pain in the abdomen . But before stone came out i had four to five times urine full of blood. but later it was fine when the stone came out.
And now i am fine with my urine but still i have a little pain in my abdomen. The ESWL treatment is absolutely fine and sucessfull.
I had a Lithotripsy treatment on Friday, it is now Sunday evening and not seeing anything like I was told I was. Supposedly the procedure was a success so when does the broken up stone begin to come out?. I will be trying to talk to my Urologist tomorrow. Does this take a few more days? Drinking all the water I’m told also. Any advice??
I’m with John. I am going to be scheduled for this procedure, with placement of a stent that will be in for at least 6 weeks. The doctor said that she can only zap stones twice, with 3 weeks in between treatments. Your web site here is very comforting. Even though the doctor explained the procedure, it is good to come back here and read and see the about the procedure. Thanks for a wonderful web site reference!
Success rate using ESWL for a 8mm kidney stone, is more than one procedure required?
A recent report found that in 200 patients treated with shockwave lithotripsy, the overall stone free rate after treatment was 55% (defined as having no visible stones on a plain x-ray after surgery). The overall success rate was 68% (defined as only having stones smaller than 4mm remaining on a plain x-ray after surgery).
Therefore, roughly 1 out 3 patients having shockwave lithotripsy may require another procedure in order to adequately treat their stones. Stone size does make a difference, with smaller stones having more success than larger stones. An 8mm stone would be considered an average size for shockwave lithotripsy.
“Shock wave lithotripsy success for renal stones based on patient and stone computed tomography characteristics”
Weld KJ, Montiglio C, Morris MS, Bush AC, Cespedes RD. Urology. 2007 Dec;70(6):1043-6; discussion 1046-7
I am going for ESWL tomorrow, I have a stone in the ureter and a large stone in the kidney. I had ureteroscopy on March 1st to try to remove the stone in the ureter but it was too far up, so they pushed it back from what I understood and placed a stent. Stent is irritating, but not as bad as the pain of the stone. I am nervous about the shockwave treatment, but hoping it’s not bad they said I will be heavily sedated. I also may have to have more than 1 treatment because of the size of the stone. Thanks for the information, it’s nice to be able to see the equipment and procedure before so you have some idea of what’s going to happen!
I have had four ESWL treatments over the past 20 years. All were very successful, with little discomfort after the treatment, and after the small stones were passed, no more pain . This is a marvelous method, and when it can be done, it is much less painful than Ureteroscopy, extractions and stents (which I have also had done). Much less painful!
And by the way, 3 or my 4 Lithotripsy’s were for stones in the Kidney, and one for a stone in the upper Ureter. All four stones (both in kidney and in ureter) had terrible pain associated with them prior to the treatment, which pain was immediately relieved after treatment. So for me, a person with 20 years experience, the idea that kidney stones only hurt in the ureter is not valid. Mine hurt in the kidney which is why I sought treatment in the firstplace.
Thank you so much for sharing your story. I am scheduled for the shockwave therapy in 2 weeks. It really helps to have some knowledge of what will happen before you go and to hear other experiences. I hear you about stones hurting that are in the kidney. Have been trying to manage pain of a really large stone in my kidney for 7 mos. due to having no insurance. It has been horrible. Finally county came through. glad to hear everything worked out so well for you. This is an excellent site.
Thank you this was great info
knew what to expect made it less intimidating