Lithotripsy (ESWL)

Lithotripsy is a non-invasive surgical procedure used to treat kidney stones.

High-energy shock waves are transmitted from outside the body to break up kidney stones. The remaining kidney stone fragments are small enough that they can more easily pass through the urinary tract. Because lithotripsy is noninvasive and highly effective, it is one of the most common treatments for kidney stones in the United States.

The more formal name for lithotripsy is Extracorporeal Shock Wave Lithotripsy (ESWL).

• Extracorporeal means it occurs outside the body.
• Lithotripsy is from the Greek words for ‘stone’ (litho) and ‘crushing’ (tripsis).

Kidney stones are usually small enough to pass through the urinary tract along with urine. In some cases, the stones are too large to pass on their own. Lithotripsy is normally used when:

• Stones are too large to pass (larger than 5 millimeters)
• Stones are blocking the flow of urine.
• Stones are causing bleeding or infection
• Pain medication isn’t effective when trying to pass stones

Some stones may be too large to treat with shockwave lithotripsy. The size, shape, location, and the number of stones will all be evaluated to see if this procedure is appropriate.

Your doctor may advise alternate treatment if you are pregnant, weigh over 300 pounds, have a pacemaker, kidney cancer, kidney infection, or on medications for cardiac conditions.

Around 3 out of 4 patients will be stone-free three months after lithotripsy treatment. If lithotripsy isn’t successful, the patient may need an endoscopic procedure to remove kidney stones.

You may or may not pass stone fragments until several weeks. In some rare cases, stone fragments may not pass for 1-2 months after treatment. After treatment:

• Drink lots of fluids! At least 8 glasses a day for several days, will help the fragments pass and decrease the amount of blood in urine
• Strain urine if requested by physician. Save all stone fragments at home and bring them to Urologist for analysis.
• Resume normal activity after 24 hours. Walking and mild exercise are beneficial, activity will help stone fragments pass.
• Take all medications as prescribed.

Common Symptoms After Lithotripsy

• Expect red-tined urine for at least 72 hours.
• You may notice slight bruising and redness on the treatment side/flank area
• Passing of stone fragments.

Call your urologist if you experience any of these problems:

• Red-tinged urine for longer than 72 hours or passing large blood clots with thick pasty urine.
• Severe pain that is not relieved by using prescribed pain medications.
• Fevers over 101.5° F

Is lithotripsy painful?

Patients will undergo sedation or anesthesia during the procedure and may experience tenderness/bruising near the treatment area. Most patients are able to control discomfort with over-the-counter pain medications.

How long does a stent stay in after lithotripsy?

Some patients may have a stent placed to prevent blockage of the urine flow from stones or swelling of the ureter. The stent will be removed once enough time has passed to allow the swelling of the ureter to resolve. Your doctor will tell you when to return to have the stent removed.

Some patients may have a small thin black string coming out of the urethra (the tube your urine comes through). This string is connected to the stent and used to remove the stent when it is time for it to be removed. If this string retracts into the urethra and cannot be seen, do not worry. This is very common.

How long does it take for a kidney stone to pass after lithotripsy?

The stone fragments may pass in within a week but could take up to 4-8 weeks for all fragments to pass.

Nearly all of Urology San Antonio’s doctors perform lithotripsy for kidney stones.  To expedite your treatment, the urologist that performs your procedure may not be your primary urologist.