Lithotripsy (ESWL) — Procedure Guide, Recovery & Risks | MyMedicPlus

Extracorporeal shock wave lithotripsy (ESWL) uses high-energy sound waves focused externally on kidney or ureteral stones to fragment them into passable particles, eliminating the need for surgical incision.

Indicated for renal or proximal ureteral stones 5–20 mm in patients with no uncorrected coagulation disorders, no active urinary tract infection, no pregnancy, and no aortic aneurysm near the target stone.

The patient lies on a water cushion. Fluoroscopy or ultrasound localises the stone. Between 1,500 and 3,500 shock waves are delivered over 45–60 minutes to fragment the stone into 2–4 mm passable particles.

Stone fragments pass in urine over 2–4 weeks. Patients are encouraged to drink 2–3 litres of water daily. A ureteral stent placed prior to treatment aids fragment passage. Activity can resume the following day.

Side effects include haematuria, perinephric haematoma (rare), colicky pain during stone passage, incomplete fragmentation, and steinstrasse (stone street) formation. Repeat sessions are needed in 20–25% of cases.

Stone-free rate for renal pelvis stones smaller than 20 mm is 80–85% at 3 months. Larger or lower pole stones have lower success rates. ESWL is preferred over surgery for suitable stone sizes due to its minimal invasiveness.