Extracorporeal Shock Wave Lithotripsy (ESWL)
What is extracorporeal shock wave lithotripsy?
Extracorporeal Shock Wave Lithotripsy, ESWL, is a non-invasive procedure used to treat kidney stones or stones located in the ureter (the tube which connects the kidney to the bladder). During the procedure, high-energy sound waves are directed at the stone from outside the body. These waves break the stone into smaller fragments that can pass more easily in the urine. ESWL avoids the need for incisions and is commonly used for stones that are suitable for targeting with imaging such as X-ray or ultrasound.
Why is it needed?
ESWL may be recommended when a kidney or ureteric stone is too large to pass naturally, or when it is causing pain, infection or urinary blockage. It may also be an option for people who prefer to avoid more invasive surgical procedures. The stone must be visible on X-ray or ultrasound so that it can be accurately targeted during treatment.
What happens during the procedure?
ESWL is usually performed under sedation or light anaesthesia to ensure comfort. You will lie on a treatment table while X-ray or ultrasound imaging is used to locate the stone. High-energy shock waves are then delivered through the skin and precisely focused on the stone.
The treatment generally lasts between thirty and sixty minutes depending on the size and position of the stone. Once broken into fragments, the pieces pass naturally in the urine over the following days or weeks. Most people are able to go home the same day.
What are the alternatives?
Other treatment options may be considered depending on the size, location and type of stone. Ureteroscopy involves passing a small telescope into the urinary tract to remove or laser the stone. Percutaneous nephrolithotomy is a keyhole surgical procedure used for larger kidney stones that cannot be treated with ESWL.
Observation may be appropriate if the stone is small and likely to pass on its own. Medications used as medical expulsive therapy may help smaller ureteric stones pass more easily.
Potential risks and after effects
ESWL is generally safe, but some temporary effects are expected. Pain or discomfort is common during the first twenty-four to forty-eight hours as stone fragments pass. Blood in the urine may occur for a short period and usually resolves within a few days.
Mild bruising on the skin or back can occur at the treatment site. Urinary tract infection may develop in a small number of cases and may require antibiotics. In some individuals, stone fragments may not pass completely, and additional ESWL sessions or another procedure may be needed.
A temporary blockage of the ureter caused by a line of fragments, known as Steinstrasse, may occur. Rarely, kidney injury or long-term changes in blood pressure can develop, although these risks are uncommon. Most people pass fragments successfully and avoid the need for more invasive surgery.
Follow-up care
Follow-up usually occurs within four to six weeks to assess whether the stone has cleared. An X-ray, ultrasound or CT scan may be used to check for remaining fragments. Additional treatment sessions may be arranged if needed.
Long-term management often includes advice on preventing further stones, such as dietary adjustments and adequate fluid intake. Regular follow up is recommended for individuals with recurrent stone disease to help reduce future episodes.
Kidney & Stones Procedures
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