Extracorporeal Shockwave Lithotripsy (ESWL)

What is ESWL?

Since its introduction in the early 1980’s, ESWL has become the main therapeutic option for the majority of renal and ureteric stones. This non-invasive treatment administers a series of shock waves generated by a lithotripter, which are targeted at the stone using an ultrasound scan for guidance. The shock waves are high-energy amplitudes of pressure which propagate through water and soft tissues with little impact, but exert enormous energy when they encounter stones. This energy fragments the stone into small pieces (ideally less than 2mm) which are then passed spontaneously in urine. The treatment is usually performed with simple analgesia only and in an outpatient setting.


After-effects of ESWL

After-effects are unwanted but mostly temporary affects you may get after having a procedure. After-effects of ESWL include;

  • Pain and discomfort. Your consultant may prescribe pain relief depending on how well your kidneys are functioning after the treatment.

  • A small amount of blood and fragments of stone in your urine. The fragments can cause renal colic which may require further treatment.

  • Bruising and broken blood vessels under the skin where your treatment was given.

Efficacy of ESWL

The main advantage of ESWL is that it treats renal and ureteric stones without an incision. This means that treatment time is dramatically reduced, ESWL takes approximately thirty minutes to one hour depending on the size of the stone. In addition, recovery time is fairly brief, most people can go about their normal day-to-day activities within one to two days. However, this can vary depending on the size of the stones and how the procedure went.

Another advantage of this treatment is that success rates of up to 90% have been reported in the treatments of renal calculi less than 2cm in diameter. However, larger calculi and those located in the lower pole of the kidney fare worse and should be considered for a surgical alternative.

Potential complications of ESWL There are a number of well-recognised complications associated with ESWL, these include;

  • Renal colic – severe pain caused by a stone blocking the flow of urine

  • Steinstrasse – a blockage in your ureter caused by pieces of broken stone

  • Infection – you may need antibiotics to treat this.

  • Perinephric haematoma – (heavy bleeding) lots of blood in your urine or blood clots.

The question of whether ESWL leads to significant renal damage and hypertension remains unanswered. There are a few contra-indications to ESWL and these include anticoagulation, pregnancy and an abdominal aortic aneurysm.


This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

20 views