Extracorporeal Shock Wave Lithotripsy (ESWL)
Using shock waves for kidney stone treatment
A Non-Invasive Way to Destroy or Break Up Kidney Stones
At Beth Israel Deaconess Medical Center (BIDMC), our Kidney Stone Service offers a variety of treatments for kidney stones. Extracorporeal shockwave lithotripsy (ESWL) is unique. It’s the only kidney stone procedure that requires no incision or placement of a device inside your body. ESWL isn’t for everyone. But for those who qualify, the treatment can be an effective way to remove kidney stones.
What is ESWL?
ESWL uses a series of shock waves to break kidney stones into small fragments. A machine called a lithotripter generates the waves. With X-ray guidance, we focus the waves on your kidney stone from outside your body. The waves travel through your skin and other tissues before reaching your stone and breaking it apart. Our goal is to break apart your stone but minimize any injury to your kidney or surrounding organs. Usually, the entire procedure takes about 30 minutes. For several weeks after your treatment, you pass the smaller stones out of your body in your urine.
Doctors have used ESWL for decades. At BIDMC, we’ve also helped to make the treatment work better and be safer for you. ESWL is usually an outpatient procedure. You go home the same day you have your treatment. In most cases, we give you anesthesia to sedate you and help keep you comfortable. Often, this helps you get the best results. But you and your doctor will decide if sedation is right for you.
More About ESWL
ESWL may be right for you if you have small kidney stones that we can easily see on an X-ray. It may not be right for you if you:
- Are pregnant.
- Have an abdominal aortic aneurysm (AAA).
- Have an obstruction or scar tissue in your ureter. They can prevent stone fragments from passing.
- Have a chronic kidney infection. Some fragments may not pass, so you won’t completely eliminate bacteria from your kidney.
- Have stones made up of cystine and certain types of calcium. ESWL doesn’t do a good job breaking these stones apart.
- Require immediate and/or complete clearance of your kidney stone.
- Take blood thinners or have a bleeding disorder. (You must stop taking aspirin or other blood thinners at least one week prior to ESWL.)
You're likely to have some discomfort for a day or two after treatment. People often describe the discomfort as a dull ache over their kidney. It’s usually the strongest the evening after your surgery, but it gets better shortly after. It's common to see blood in your urine for several weeks after your procedure. But if you have large amounts of blood or blood clots in your urine, it could be a sign that your kidney was injured during treatment. Alert your doctor as soon as possible.
Other signs of a potential problem that you should bring to your doctor's attention include:
- Fever, which may indicate you have a serious kidney infection.
- New onset pain or pain that's getting worse instead of better. This could indicate that you have bleeding around your kidney or that kidney stone fragments have fallen into your ureter (the tube that carries urine from your kidney to your bladder) and are blocking urine drainage.
Several weeks after your treatment, we perform a follow-up X-ray. The X-ray helps us determine if your stone broke up into small pieces and if those pieces passed out of your kidney. If we find that the stone did break into fragments, but the fragments haven’t cleared, we may repeat the X-ray in a few weeks. If the stone hasn’t broken apart, we usually recommend further treatment. More ESWL treatments are unlikely to be successful in these cases. So, we typically recommend other methods of kidney stone removal, such as ureteroscopy or percutaneous nephrolithiasis.
