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.

218 Responses to Shockwave lithotripsy (ESWL)

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  2. Phillip Webb says:

    I’m going in for my second lithotripsy in a month .I have a 9 to 10 mm stone .This is my third lithotripsy in 7 years but I have passed 3 others stones on my own.My advice is ,once you get your stones out follow up with your urologist once a year for check up of stones .My urologist told me Fresh lemonade is the best thing t

  3. Audrey ellenwood says:

    I just had lithotripsy for a 9 mm stone that I had for 30 years. The procedure was good felt nothing and it took 1.5 hours. The pain and pressure following was severe and nothing helped. Felt like severe menstral cramps coupled with the pressure of diarreha without diarreha. Went on for two days. Now day three stent is uncomfortable but pain gone running fever 100.7. Hopefully will never have again.

  4. Terence McLaughlin says:

    I have an 8mm stone in my ureter. Can anyone tell me whether litotripsy was successful for them in the ureter, for a stone of this size or similar?
    I really don’t want to undergo a ureter occupy!
    Much appreciated.

  5. Kristen says:

    I learned the hard way, so I’m sharing here. You have lots of options to manage pain during a low-level procedure like ESWL! They include: pain meds only (from fully awake to loopy if you need lots, called PCA if you push the button), regional (epidural/nerve block, numbs large area, with or without sedation), conscious sedation (or twilight sleep, awake with pain meds, no memories), MAC (basically deeper conscious sedation) and general anesthesia (unconscious, on ventilator, with pain meds). Usually, the deeper you go, the larger number of drugs.
    Before procedure-day, ask your doctor about options. It’s your choice, not theirs, and it depends on: location of stone, pain tolerance, medical history, sedation preference, drug preferences, procedure length, etc. Some anesthesia methods are associated with higher stone-free rates, but the percentage differences aren’t huge.
    If you choose general anesthesia, in addition to pain meds and the drug that keeps you unconscious, there are often drugs for convenience/comfort. These are benzos, propofol and anti-nausea. Before you get an IV, talk to the anesthesiologist. Ask which drugs they’ll use and what each one does–you may be able to opt out of some.

  6. RDI says:

    How many times can be done ESWL? Maximum without kidney injury . Please help

  7. Diann says:

    I had this procedure done. It was my first time. One stone 13mm. I am 64 so I was quite concerned of the out come. It has been three days and I have not passed stones. Had a stent put in also. This is a fairly new experience with a lot of different results. Though I took pain pills, I was still careful how I treated my body, rest. Wait atleast three days before you get out and about. I was very sore after the procedure and the pills will fool you into thinking that you can do everyday chores, but you have to remember that after such procedure you can not bounce back like a spring chicken. Relax, and drink plenty of water and use your common sense to continue having the stones removed. Google other sights for the right foods to eat and not to eat. It will help you in the future from getting more stones. You will have to do good research on the cause of stones and how to prevent them from returning. Prevention is one subject that is missing when you keep going back for treatment. I am waiting to see my doc in two weeks to see if my stones are still there. The procedure is worth money to have done. GOD first.

    • Thanks Diann. I am almost at the same shape (at age 64, with 93 Kg. weight and a long heart and lungs failures, and I had 4 stones) and the heavier and most painful- 43mm- was crashed and taken out by a successful PCNL operation in Iran. It was wonderfull. A team of 5 expert bsurgeons in kidney operation worked on my left kidney for about 3 hours, and due to my heart condition, they had to stop extraction of a 13-15mm stone. Now I have been instructed to do an ESWL, by the next week and will do it. Amazingly the total cost for my operations has been about (and so far) 50 US$, even receiving the best services at the hospital for 4 days and 3 nights. Thanks for yourb brifing Diann. I am living in Iran and the operation was carried out in Tehran. I beleive in you for the almighty God’s helps. Ali.

  8. Cori says:

    I had this procedure. It is my first time. One stone 13mm. I am 64 so i was quite concerned of the out come. It has been three days and i have not passed stones. Had a stent put in. This is a fairly new experience with a lot of different results. Though you take pain pills, still be careful how you treat your body, rest. Wait atleast. Three days before you get out and about. You are very sore after the procedure and the pills will fool you into thinking that you can do everyday chores, But you have to remember that after such procedure you can not bounce back like a spring chicken. Relax, and drink plenty of water and use your common sense to continue having the stones removed. Google other sights for the right foods to eat and not to eat. It will help you in the future from getting more stones. You will have to do good research on the cause of stones and how to prevent them. That is one thing that is missing when you keep going back for treatment. I am waiting to see my doc in two weeks to see if my stones are still there. The ptocedure is worth money to the doctors. GOD first.

  9. cody says:

    I’m 33 and I’ve had over 50 kidney stones since the time I was 18. They have ranged from too small to feel to the biggest one was 11.4 mm and shaped like a peanut. The most common size I get is around 4 to 6 mm. Even the little ones will almost cripple you. I’ve had the shockwaves done twice. Each time it was for multiple stones. Last time they busted up 12 stones on my right side. Unless your getting multiple stones busted up or a really large one I wouldn’t bother with the shock wave. Drink plenty of cranberry pomegranate juice and take flowmax and pain meds

    • abid says:

      Know u feel good or not and ur creatinine and blood urea level is normal i also stone former and very afraid of doing lithotripsy

  10. Steven Watts says:

    I just had ESWL how long before I see any pieces of the stone come out my doctor said he thinks he got it

    • cody says:

      I passed my first piece within 10 minutes of waking up from the procedure and pieces kept coming out for up to 3 weeks after

  11. Robert Hill says:

    In August 2015 I had litho performed on my right kidney for multiple stones. They had me knocked out with general anesthesia during the process, so I felt nothing. However, the first time I peed, which was immediately after waking, it hurt like hell. Almost as bad as the first time after waking from ureteroscopy, which I experienced on Sept. 8th this year. And unfortunately, I have to do it again on the 29th.

    Have a large 9mm stone in my right ureter that the doc is having a hard time getting out. Don’t know how many more of these I can tolerate. Have a stent in now, bypassing the stone so my kidney can drain. It was all puffed up, as was the ureter. Not even sure at this point, if my right kidney will still be with me when this is all done.

  12. katincanada says:

    Just experienced Litho 3 days ago for the first time on a 1 1/2 cm stone in my right kidney. I experienced no pain during the procedure at all and the sedation they gave me only put me to sleep for about 20 mins I was awake for pretty much the entire procedure.. I didnt have any redness or bruising on my back from it either, no pain afterwards nothing… I was told by the Dr that he could see the stone was broken up and sitting at the bottom of the kidney and I should be able to pass them with no problem.. I can’t tell if I am as with the strainer they gave me all I am seeing is fiber like strands and only a couple of them thus far. Nothing in a solid matter, wondering if this is how it would look and how would I know if it didnt really work prior to having another xray which isnt until another 2 weeks from now. I never had pain from the stone prior to the litho and none after.But as far as the treatment went I had no problems at all .. it was a total breeze, the worst of it all was the intervenus injection which I hate.

    • Richard Allen says:

      Sounds exactly what I just went through. No pain during or after. Very small pieces pass in urine. The one stone targeted was over 1.2cm, so doctor said smaller stones remain. Later x-ray will show results. Stent was placed three weeks earlier to prevent accumulation of particles and to drain right kidney. This is my third problem in about 9 years. All I can do is drink.lots of water and keep eating phyllanthus leaves which helped.before.

    • Phyllis says:

      i see you noted the stones were now at “bottom” of kidney after this procedure. Did you ever pass the stones? I just had same procedure ab 1 month ago. I got 2nd opinion and he says it will not drain bc it is at the bottom of my kidney. He says I need the PCNL done to remove them.

  13. John Garcha says:

    I have 4mm stone stuck in mid left ureter, can lithotripsy be used in this situation? Do not want to have ureteroscopy.

  14. Bhavesh says:

    I hve multiple stone in left kideny in 4 5 10 mm and right kideny 14 16 and 4 mm stone so is it possible lithotripsy

  15. Keith says:

    I have had three kidney stones over the last five years. I have had litho done on all of them with no issues any of those times. I just got another stone, yeah, and will be scheduling my litho this coming week. They wanted me to try for one week to pass it on my own, no go. My Dr. is very experienced doing the procedure and has blasted the others into little bits that I then pass before. Personally, I prefer litho to weeks/months of suffering.

  16. Grant Fletcher says:

    I had Lithotripsy on 4th May, 55 minutes 5000 shocks which increase in intensity and I might add, also in pain. I opted only for Diclophenac suppository pain relief. From diagnosis to Litho, around 6 weeks, my stone increased from 6mm to 9mm. The pain was very intense during the procedure, but I did cope ok. X-ray afterwards showed it had altered in shape and only chipped away at edges. They booked me back for a repeat on 25th May, now changed to 30th May ? Because an X-ray yesterday showed my stone in a position which I couldn’t get the Litho ?? They said it needs to move around 2 cm first. More excercise and water to move the stone is what I was told !! What if this doesn’t move ? Western General is over 2 hours from my home !! After Litho, i peed blood once and gritty bits. Then I spent 12 hours in agony trying to pee all through the night, eventually, drinking gallons of water, I managed, since then, till now , no pains. I only hope I do not go through that next time

    • Kristen says:

      I hope you’re now stone-free! My ESWL was totally successful, but I’ve had months of complications from the anesthesia. May I ask:
      In what country was your procedure performed? What was the location of your stone on May 4th (kidney, ureter, distal ureter)? Am I understanding that diclophenac was the only pain medication during the procedure? If not, do you know what medications you used and how they were given (IV, oral, etc.)? Did they have to refocus the lithotripter often? Were you able to hold very still and if not, do you think your movement extended procedure time?
      My procedure was 35 minutes (excluding prep and wake up), 2500 shocks on a 6mm stone in my distal ureter. I had general anesthesia (unconscious on a ventilator), so I felt nothing during the procedure. Afterward, I had zero pain, bruising or nausea. I peed blood and grit about twice and that was the end of the stone. It sounds like you tolerated much worse with almost no anesthesia. If I get another stone, your answers will help me feel confident in insisting on something less drastic for pain management.

      • Jenny says:

        They prefer to do do propofol in the northeast USA. I wish we had options, but the doctors insist you do it their way. In England it seems like a trip to the dentist. Here the treat it like a surgical procedure. It can’t hurt more than labor!

        Will be having it soon- wish I had a choice.

  17. Niranjan Punja says:


    My mother is having 5 mm stone in kideny, its been already 1 year 7 months, she has used so many tablets and took water but still it didnt go..
    Can she under go the ESWL treatment, because I read so many negatives about this and more chances of diabetes and high blood pressure. Can you please suggest me is it better to have treatment for 4mm stone.. because she is having pain continuously from long time.. kindly suggest.

    • Jenny says:

      They now say that the original research showing diabetes is not reproducible, meaning they now show no increase in long term problems. If your mom can take pain meds, i’d wait a bit longer, but it should be safe for her.

  18. Charles Corum says:

    My urologist recommended lithotripsy for a 8mm in the lower portion of my left kidney, which has been there for 4-5 years and hasn’t moved. My concern with lithotripsy is reported damage to the pancreas, causing diabetes, and damage to the kidney itself, resulting in high blood pressure. At present, my BP is very low, as is my blood sugar. How great is the potential for damage to the pancreas or the kidney?

    • Jenny says:

      New research/analysis has not shown that ESWL has less of an impact than previously thought on long term health. I am in the same boat as you. What did you decide?

  19. salman says:

    i have 10 mm stone.. but doctor did lithotripsy only for 5 min.. is it right ???
    plz help me

  20. Robert says:

    I have a 11 mm stone just barely out of the kidney in the tube leading to bladder
    Scheduled for the lithrotripsy but now alittle worried after reading all the replies on the internet it seems as if no one has any good experiences ???? Can anyone give me any positive reports ?? I heard it is worse the stone is in the tube vs the kidney as I assume it’s because they don’t break up as bad in the tube ?
    I just lost my son to what I believe was simply oversight by doctors and frankly I’m just concerned. Can anyone give me any experience or also advise me what kind of questions I SHOUKD be asking.
    Thank you

  21. Muhammad Afzal says:

    my right kidney has 4mm stone please tell me its treatment

  22. Beatrice Shelton says:

    I am obese and have been told that I am to large to have my stone blasted. It is 8mm and in the upper left quadrant of my right kidney. I asked the doctor what i should aim for in my weight loss but he did not say.. He was the doctor in the hospital and not my reg PCP. Could you help please?

  23. Greg blackwell says:

    I have been using a lithotripsy machine since 1987, I have noticed these blisters do occur it’s not from latex for these machines are latex free, the blisters are from the shock way entering the body it’s not often but it does occur mostly on fair skin individuals nothing to worry about

  24. Dattakumar says:

    Hi, im 29 years old and i have a stone of 10mm in my left kidney. How much it cost to take it out . My number 9177234858

  25. Roy Marshall says:

    I drink about 3 to 4 pots of coffee a day plus work in sun during day in Phoenix AZ and so I get a stone a year usually. Most pass, but today had a 10 mm one blasted.. Everything went well until I 8 hours later I noticed a huge red rash with blisters on my side where they had the X ray head against my skin. I was unaware that the x ray videograph would give enough radiation to cause what I can only think is an X ray burn. Supposedly max radiation should only be in the .8 to 1.2 milli seiverts which is like around a hundred REM or so which shouldn’t do anything. Anyone have any other similar incidents like this. It’s the middle of the night and can’t call the hospital until morning, but is causing some concern

    • M says:

      Are you sure it is because of X-Rays? The flouroscopy they use for localization is quite low radiation…Is it possible you have a rash from say Latex or the cover for the ESWL head where the shockwaves come from? I would check it out. Say taking some strong Anti-histamine…

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