Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure healthcare providers use to treat kidney stones. It uses high-energy shock waves to break up stones. This can remove blockages and allow you to pass (pee out) the stone fragments. It may take days to weeks after the procedure to completely pass stones.
Extracorporeal shock wave lithotripsy (ESWL) is a common, nonsurgical procedure to treat kidney stones. It uses high-energy shock (pressure) waves to break up stones. Tiny pieces of the stones can then move through your urinary tract and out of your body more easily.
Kidney stones are rock-like masses that form when you have high levels of certain substances (like calcium) in your pee (urine). They form inside your kidneys but can move into your ureters (the tubes that carry urine to your bladder).
Many kidney stones pass on their own — they move through your urinary tract and you pee them out. But sometimes, a kidney stone becomes too big to move through (or gets stuck inside). Pain during a “kidney stone attack” is typically due to a stone getting stuck in your ureter and blocking drainage of pee from your kidney.
ESWL can dislodge the stones and allow you to pass them on your own.
Providers often use ESWL to treat kidney stones that:
When recommending a procedure to treat kidney stones, healthcare providers consider:
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Your healthcare provider will explain how to prepare for ESWL. You may need to:
Before ESWL, a provider will give you anesthesia (pain relief) to keep you comfortable. You may be asleep or awake but drowsy during lithotripsy. Or you may have regional anesthesia, which means you’ll be awake but numb from the waist down.
ESWL usually takes about an hour. Your procedure may take more or less time, depending on the size and number of kidney stones you have and your overall health.
ESWL is usually an outpatient procedure (it doesn’t require a hospital stay). You should go home the same day but expect to spend a few hours in the recovery room.
If you have general or regional anesthesia, you shouldn’t feel pain during the ESWL procedure. Most people who have the procedure without anesthesia (they’re given pain medication beforehand instead) report feeling mild to moderate pain during ESWL (ranking it a 6 or lower on a pain scale of 0 to 10). About 30% of people who have ESWL without anesthesia experience severe pain (a 7 or higher on a scale of 0 to 10) during the procedure.
ESWL can help you pass kidney stones on your own without needing more invasive surgery to remove them.
Potential risks of ESWL include:
In some cases, shock wave lithotripsy doesn’t break up a stone enough for all the pieces to pass on their own. If that happens, you may need another procedure.
Depending on your situation, your provider may recommend a second ESWL or a ureteroscopy, a minimally invasive way to clear remaining stones. Talk to your healthcare provider about the different types of kidney stone treatments.
Most people get back to their usual routines within a few days of ESWL. But you may have lingering side effects until your body has passed the last of the stone fragments. As you recover from ESWL, you may experience side effects like:
These symptoms usually go away after a few days.
You can expect to pass kidney stone fragments in your pee for several days to weeks after the procedure. Stone pieces may look like sand, gravel or dust.
Expect to feel some discomfort as stone fragments pass. Pain may come and go until all the kidney stone pieces have worked their way out of your body.
To help move the stone out and manage pain, your provider may prescribe:
Take any medications as prescribed. You may also be able to take over-the-counter (OTC) pain medication to keep you comfortable until you’ve passed all the stone fragments. Ask your provider what medications are safe to take.
Yes, it can hurt to pee for a few days after shock wave lithotripsy. And passing stone fragments (even tiny ones) can hurt — sometimes a lot. Ask your provider what to expect and when to let them know about painful urination.
Success rates for ESWL vary widely (from 30% to 90%). The success rate can depend on:
You have a higher chance of success if the kidney stone is inside certain parts of your kidney or the upper part of your ureter.
Your provider will give you instructions on how to take care of yourself after ESWL. They may ask you to:
Contact your provider if you have any questions before or after the procedure. This includes questions about how the procedure works, how to take your medications and any concerns about symptoms you have after the procedure.
Go to the emergency room if you have:
Some medical conditions could make shock wave lithotripsy less effective or riskier for certain people. Your healthcare provider may recommend against shock wave lithotripsy if you’re pregnant or have:
A note from Cleveland Clinic
ESWL is a safe, noninvasive treatment for breaking up kidney stones. It’s an option for many people that allows stones to pass on their own, without surgical procedures. But many factors, such as stone size and location, can impact its effectiveness. Certain health conditions can also increase your risk of complications from ESWL. Talk with your provider about what to expect and whether shock wave lithotripsy is the right kidney stone treatment for you.
Last reviewed by a Cleveland Clinic medical professional on 11/21/2023.
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