Extracorporeal Shock Wave Lithotripsy (ESWL)

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive procedure for treating kidney and ureter stones. It uses high-energy shock waves to break stones into tiny fragments that can be passed naturally through urine.

About Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a non-surgical treatment for kidney and ureter (a tube that carries urine [pee] from a kidney to the bladder) stones. 
High-energy shock waves pass through the body to break stones into tiny pieces, allowing them to pass naturally through urine.

Uses

ESWL treats kidney and ureter stones that are difficult to pass naturally. It is most effective for smaller stones seen on X-rays or ultrasound.

How It Works

During ESWL, shock waves target the kidney/ureter stones, breaking them into small pieces. There are 2 methods for this treatment:

  1. The patient sits in a tub of lukewarm water while X-rays or ultrasound guide the shock waves
  2. The patient lies on a cushion through which shock waves pass. This treatment typically requires 1-to-2 thousand shock waves and lasts 45 to 60 minutes

Types

ESWL can be performed using different systems, typically performed in a medical facility such as a hospital or specialized clinic. Here’s how each one works:

  • Electrohydraulic: 
    Creates shock waves by making a tiny spark underwater between two metal points. These shock waves are then directed at kidney stones to break them into smaller pieces. Imagine it’s like a little, controlled underwater firework that sends waves to crack the stones apart.
  • Electromagnetic: 
    Uses an electromagnetic coil to create shock waves. A magnetic field generates powerful shock waves when electricity flows through the coil. These waves are aimed at kidney stones to break them into smaller pieces by using robust and focused energy waves to shatter the stones.
  • Piezoelectric: 
    Unique crystals, like quartz or certain ceramics, change shape when electricity is applied. This change creates shock waves aimed at kidney stones to break them into smaller pieces. It's similar to how quartz crystals in a watch vibrate to keep time, but the vibrations create waves that can crush the stones here.
  • Laser lithotripsy: 
    Laser lithotripsy is a way to break up kidney stones using a laser. The doctor uses a small, flexible tube that goes through the urethra (the tube that carries pee out of your body) and into the bladder to find the stones. Think of the laser as a powerful beam of light that smashes the stones, making them small enough to pass out of your body more easily or be removed by the doctor.

Ask your healthcare provider which type of ESWL is best for your kidney/ureter stone

Effectiveness

ESWL is a widely used, noninvasive procedure for treating kidney stones. It employs shock waves to break stones into smaller fragments that can be passed more quickly through the urinary tract.

The effectiveness of ESWL depends on several factors, including the size, type, and location of the kidney stones. Studies have shown that ESWL has a higher success rate for small-to-medium—sized stones, particularly those in the kidneys or upper ureter.

  • Success Rates: ESWL is reported to be effective in almost 70% to just over about 90% (after repeated ESWL treatment) of cases for stones smaller than 2 cm. Larger stones or those in the lower ureter may require additional treatments or alternative methods.
  • Non-Invasive: ESWL avoids the risks associated with surgery and typically has a shorter recovery time than a non-invasive procedure. Patients can often return to normal activities within a few days.
  • Pain Management: Pain management during and after the procedure is typically well-handled with sedation and pain medications, making the treatment relatively comfortable for most patients.
  • Follow-Up: Multiple sessions may be needed to clear the stones completely, and follow-up imaging is usually performed to ensure the stones have been adequately fragmented and passed.

Side Effects

Patients may experience some blood in their urine and discomfort as stone fragments pass. In some cases, additional treatments may be needed to remove all fragments entirely.

Additional Considerations

Anesthesia and Hospitalization

Some anesthesia is usually required, and patients are typically hospitalized for a day or two, though outpatient procedures are possible.

Post-Treatment Expectations

Patients can usually resume daily activities within one to two days. Drinking plenty of water helps pass the stone fragments, and oral pain medication can relieve any discomfort.

Questions for Your Healthcare Team

  • Is ESWL the best option for my type and size of kidney stones?
    You should ask questions and understand the answers to determine if ESWL is the best treatment for your specific condition – eg, some stones may require different treatments depending on their size, location, and what they are made of
  • What are the potential risks and side effects of ESWL?
    Knowing the risks and side effects helps you weigh the benefits against the potential drawbacks and prepares you for what to expect after treatment
  • Will I need additional treatments after ESWL?
    Understanding that – before agreeing to initial ESWL treatment – additional treatments might be necessary helps set realistic expectations – and allows you to plan for further medical care/discussion if needed
  • How should I prepare for the procedure?
    Proper preparation can improve the effectiveness of your treatment and reduce the risk of complications, ensuring a smoother procedure and recovery. 

Acknowledgment: This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.

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This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.
© 2024 National Kidney Foundation, Inc.