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Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a procedure that uses high-energy shock waves to break down kidney stones into small crystals. You can then pass them out of your body in your urine.

Kidney stones are small, hard stones that can form in one or both of your kidneys. You can get them if there’s an imbalance of salts or minerals in your urine. The stones are often small enough to pass harmlessly out of your body in your urine by themselves. But if they can’t, your doctor may advise you to have ESWL.

Your care may not be quite as we describe here as it will be designed to meet your individual needs. But you’ll meet the doctor carrying out your procedure beforehand to discuss what will be involved.

Extracorporeal shockwave lithotripsy (ESWL)
A procedure that uses high-energy shockwaves to break down kidney stones


  • Preparation Preparing for extracorporeal shock wave lithotripsy

    Your doctor will explain how to prepare for your procedure.

    Extracorporeal shock wave lithotripsy (ESWL) is usually done as an outpatient or day-case procedure, without the need for any anaesthesia. This means you’ll be awake during the procedure and can go home the same day. Your doctor may offer you a sedative to help you relax and an injection of painkiller too.

    You can drink clear fluids such as water on the day of your procedure but don’t eat anything in the four hours beforehand.

    If you take medicines, such as tablets for blood pressure, continue to take these as usual unless your doctor tells you not to. If you’re unsure, contact the hospital.

    Your doctor or radiographer will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help you to inform yourself about the procedure so you can give your consent for it to go ahead. You’ll be asked to sign a consent form.

    An image showing the location of the bladder and surrounding structures
  • Alternatives What are the alternatives to extracorporeal shock wave lithotripsy?

    You might be able to have alternative treatments – this will depend on the size, density and position of your kidney stone. Here are some other options.

    • Ureteroscopic stone removal. If you have a kidney stone lodged in your ureter, your surgeon can use laser beams to break up kidney stones. Ureters are the tubes that connect each kidney to your bladder. A long, thin instrument called a ureteroscope is fed through your bladder and into your ureter to send laser beams to break up the stone. You’ll usually have a general anaesthetic for this procedure. Your surgeon may put a stent in your ureter to stop any further blockages.
    • Percutaneous nephrolithotomy (PCNL). If the stone is large or in an awkward place, your surgeon will pass an instrument through your back into your kidney to remove it. This procedure is usually done under general anaesthesia.
    • Medical expulsive therapy (MET). If your kidney stone is less than 10mm (1cm), your doctor may give you medicines to help the stone pass out in your urine.
  • The procedure What happens during extracorporeal shock wave lithotripsy?

    Extracorporeal shock wave lithotripsy (ESWL) takes about 30 minutes to an hour. Usually, you’ll only have one kidney treated per session.

    The technician or nurse carrying out the procedure will ask you to lie down, on either your front or your back. This depends on whether the kidney stone is in your kidney or ureters. They might give you some headphones to wear, as the machine can sometimes be loud.

    Your technician or nurse may use ultrasound to pinpoint the exact position of your kidney stone or stones. They will then apply a gel to your skin, and use a device called a lithotripter sensor to direct shock waves onto each kidney stone. They will gradually increase the intensity of the shock waves they deliver. Try not to move during the treatment as the kidney stone could move out of position.

    You might get some pain in your kidneys and a stinging pain in the skin on your back from the shock waves.

    Depending on how many kidney stones you have, you may need to have more than one treatment to completely get rid of your stones.

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  • Aftercare What to expect afterwards

    You may need pain relief to help with any discomfort. Your doctor will usually prescribe strong painkillers for the first couple of days, and they may give you antibiotics to reduce the risk of infection.

    Your nurse will do some checks to make sure you’re recovering well. They will give you a date for a follow-up appointment before you go home.

    If you have had a sedative, you might find that you're not well coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important. If you can, try to arrange for somebody to take you home.

  • Recovery Recovering from extracorporeal shock wave lithotripsy

    Once you get home, it's best to take it easy for the rest of the day. Most people feel able to get back to their normal activities within a few days. It’s important to drink plenty of water in the first 24 hours as this will help flush the kidney stone fragments out of your body (see What should I do after extracorporeal shock wave lithotripsy?).

    You’ll probably feel some pain and discomfort as the stone fragments move out of your kidneys. Continue to take your painkillers as your doctor instructed you to. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your doctor or pharmacist or doctor for advice.

    It’s important to attend your follow-up appointments after your treatment to check that you have got rid of all of the kidney stone fragments.

  • Side-effects Side-effects of extracorporeal shock wave lithotripsy

    As with every procedure, there are some risks associated with extracorporeal shock wave lithotripsy (ESWL). We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of ESWL include:

    • pain and discomfort
    • some blood and fragments of stone in your urine for two or three days
    • bruising or blistering on your skin where the treatment was given
  • Complications Complications of extracorporeal shock wave lithotripsy

    Complications are when problems occur during or after the treatment. Specific complications of extracorporeal shock wave lithotripsy (ESWL) include:

    • a urinary tract infection – you may need antibiotics to treat this
    • a blockage in your ureter – if stone fragments get stuck in your ureter, you may need an operation to remove them
    • kidney damage – your kidney may be bruised or get infected

    Contact your GP straight away if you develop sudden spasms of pain or get:

    • severe pain when you pass urine, or you cannot go to the toilet at all
    • a fever
  • FAQ: After treatment What should I do after extracorporeal shock wave lithotripsy?

    It's important to drink enough water after having ESWL. Aim for enough to make your urine clear rather than yellow. This will help to flush the kidney stone fragments out of your body.

    More information

    Once the kidney stones are broken down, they’ll usually pass out of your body when you go to the toilet. You’ll need to drink enough water throughout the first few days to help flush them out.  This is why you need to drink enough water to make your urine clear rather than yellow.

    In the long term, continue to drink enough water to keep your urine clear and eat a healthy balanced diet.

    Your doctor may advise you to cut down on how much salt you eat. They might suggest you cut down on animal proteins such as meat and fish, and foods that have high levels of oxalate too. This is found in foods such as spinach, nuts, chocolate, tea, rhubarb and strawberries. But don't change your diet without first getting advice from your doctor or a dietitian.

  • FAQ: Bottled or tap water Should I drink bottled or tap water after extracorporeal shock wave lithotripsy?

    In the UK, it's perfectly safe to drink tap water so there’s no need to drink bottled water unless you want to.

    More information

    UK tap water is among the safest in the world and it’s cheaper than bottled water. It’s sourced from natural underground wells, reservoirs, lakes and rivers, and is carefully treated. Although natural mineral waters may sometimes contain more minerals than tap water, the amounts are so small that they’re unlikely to have any health benefits.

  • FAQ: Further treatment Will I need more treatment after extracorporeal shock wave lithotripsy?

    You may need further treatment if your kidney stones don’t clear. You’ll probably also need regular check-ups to make sure new kidney stones are picked up early.

    More information

    If extracorporeal shock wave lithotripsy (ESWL) doesn’t work, your doctor may recommend you have the treatment again, or consider an alternative treatment. It’s important to clear all your kidney stones to avoid any long-term problems. ESWL can remove nine out of 10 stones in adults. The success of your treatment depends on:

    • the size, density and position of your kidney stone
    • how still you are during the treatment
    • your doctor’s level of experience

    It's possible to get kidney stones again in the future. Your doctor may suggest you have regular check-ups so that any new kidney stones are treated before they cause problems. During these follow-up visits, you might have:

    • blood tests – to check the levels of certain minerals which cause kidney stones
    • 24-hour urine collection – to check the levels of certain minerals such uric acid, oxalate, phosphate and calcium in your urine
    • an imaging scan – to look for stones
  • Other helpful websites Other helpful websites

    Further information


    • Srisubat A, Potisat S, Lojanapiwat B, et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database of Systematic Reviews 2014, Issue 11. doi:10.1002/14651858.CD007044.pub3
    • Map of Medicine. Kidney Stones. International View. London: Map of Medicine; 2013 (Issue 3).
    • Nephrolithiasis. BMJ Best Practice., published 28 January 2015
    • Lithotripsy for stones. The British Association of Urological Surgeons., published March 2014
    • Ureteroscopic stone removal. The British Association of Urological Surgeons., published March 2015
    • Percutaneous (keyhole) removal of kidney stone(s). The British Association of Urological Surgeons., published March 2014
    • Personal communication, Professor Raj Persad, ChM, FRCS(Eng), FRCS(Urol) FEBU, Consultant Urological Surgeon, 6 December 2015
    • Urology. OSH operative surgery (online). Oxford Medicine Online., published October 2011
    • Guidelines on urolithiasis. European Association of Urology., published March 2015
    • Extracorporeal shockwave lithotripsy. Medscape., published 29 January 2015
    • Kidney stones. The British Association of Urological Surgeons., accessed 9 December 2015
    • Kidney stones. American Urological Association., accessed 9 December 2015
    • Dietary advice for stone formers. The British Association of Urological Surgeons., published March 2014
    • Drinking water quality in England: the position after 25 years of regulation. Drinking Water Inspectorate., published July 2015
    • Water quality standards. Water UK., accessed 9 December 2015
    • Water for life. Department for Environment Food and Rural Affairs., published December 2011
    • Bottled water information and FAQs. Natural Hydration Council., accessed 9 December 2015
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, February 2016.

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