Extracorporeal Shock Wave Lithotripsy (ESWL): Procedure, Uses, and Recovery

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive outpatient procedure that uses focused high-energy acoustic pulses to fragment kidney stones and ureteral calculi into passable particles.

How It Works

• Shock waves generated outside the body (electrohydraulic, electromagnetic, or piezoelectric source).
• Focused via water cushion or gel coupling onto the stone (localized by fluoroscopy or ultrasound).
• Mechanical stress fractures the stone along crystalline planes.
• Fragments (<2–4 mm) pass spontaneously in urine over days to weeks.

Indications

• Renal stones <2 cm (optimal <1.5 cm).
• Proximal ureteral stones <1 cm.
• Patients unfit for anesthesia or invasive surgery.
• Pediatric stones (with size adjustments).

Contraindications / Cautions

• Pregnancy (fetal risk).
• Bleeding disorders / anticoagulation (hold per protocol).
• Aortic aneurysm near target.
• Untreated UTI (treat first).
• Obstruction distal to stone (stent/nephrostomy first).
• Morbid obesity (targeting difficulty).
• Cystine or brushite stones (poor fragmentation).

Procedure & Recovery

• Duration: 30–60 minutes; sedation or light anesthesia.
• Post-op: Hydration (2–3 L/day), strain urine, NSAIDs for flank pain.
• Stone-free rates: 70–90% for renal <1 cm; 50–70% for 1–2 cm; lower for ureteral.
• Retreatment often needed for larger/harder stones.

Complications

• Perinephric hematoma (rare, <1%).
• Steinstrasse (fragment column causing obstruction).
• Transient hematuria (near universal).
• Renal colic from fragment passage.