Shockwave treatment for kidney stones (Extracorporeal shockwave lithotripsy (ESWL))

A non-surgical treatment that uses focused sound waves to break kidney or ureter stones into small pieces you can pass in your urine.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It breaks kidney or ureter stones with focused sound waves from outside the body, so you can pass the pieces in your urine.
It does not always clear the stone in one go — more than one session is commonly needed, and it works less well for large or very dense stones.
Passing the fragments can cause pain for days to weeks, and there is usually some blood in the urine afterwards.
It treats the stone but not the cause; ask what made the stone form and how to reduce the risk of more.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeNon-surgical day-case treatment

AnaestheticUsually none, with painkillers; sometimes light sedation

How long it takesAbout 45 minutes to an hour per session

Hospital stayDay case, no hospital stay

Time off workOften a day or two; many return to work quickly

When you'll see resultsFragments pass over days to weeks; more than one session may be needed

On the NHS?Widely available on the NHS for suitable stones

A general guide. Your specialist will give you advice for your situation.

Best fit

Treats many stones without surgery, cuts or a hospital stay

Pause if

You are, or might be, pregnant.

Main recovery point

You can usually go home the same day. Expect blood in the urine and a dull ache. Drink plenty of fluids and take painkillers as advised.

Good aftercare

Clear instructions on the warning signs of infection and blockage, and who to contact urgently.

First 24 hours

You can usually go home the same day. Expect blood in the urine and a dull ache. Drink plenty of fluids and take...

First few days

Fragments begin to pass, which can cause waves of pain (renal colic). It can help to pass urine through a sieve to...

1–4 weeks

Most fragments pass over this time. A follow-up scan or X-ray may be arranged to check whether the stone has...

If the stone has not cleared

A repeat ESWL session or a different treatment may be recommended. More than one session is common.

Medical line illustration of kidney stone in the urinary tract for Shockwave treatment for kidney stones. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is shockwave lithotripsy (ESWL)?

Shockwave lithotripsy (ESWL) is a way of treating kidney or ureter stones without surgery. A machine sends focused sound waves (shockwaves) through the skin and onto the stone, aiming to break it into small pieces that you can then pass in your urine.

It is done from outside the body — nothing is inserted to break the stone. The stone is pinpointed using X-ray or ultrasound, and the shockwaves are aimed at it while you lie on a couch or table. The treatment can be uncomfortable, so painkillers are usually given, and sometimes light sedation.

ESWL works best for certain stones — generally smaller ones, in reachable positions, and not too hard or too far from the skin. It is often less successful for large, very dense stones, and more than one session is commonly needed to clear a stone fully.

It does not stop new stones forming. Once your stone is treated, it is worth finding out why it formed and what changes might lower the chance of more in the future.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

ESWL for kidney stones

Used for suitable stones inside the kidney. Success depends on the stone's size, position and density; larger or harder stones are less likely to clear in one session.

ESWL for ureter stones

Used for some stones that have moved into the ureter (the tube from kidney to bladder). The stone is targeted in place, and fragments then pass down into the bladder.

Imaging used to aim the treatment

The stone is located with X-ray or ultrasound so the shockwaves can be focused accurately. Not all stones show up well enough to be treated this way.

When other treatments are better

Larger, harder or awkwardly placed stones may be better treated with ureteroscopy (a telescope passed up to the stone) or keyhole kidney surgery (PCNL).

Common ways to treat stones

Treatment	How it works	Best suited to
ESWL (shockwaves)	Breaks the stone from outside the body	Smaller, reachable, less dense stones
Ureteroscopy	Telescope passed up to break/remove the stone	Ureter stones, harder stones
PCNL (keyhole surgery)	Stone removed through a small cut in the back	Large or complex kidney stones

ESWL avoids surgery and anaesthetic but may need repeating and is less reliable for large or dense stones. Your urologist will recommend the best option for your stone.

Preparing for your procedure

Have your stone assessed with a scan, as size, position and density affect whether ESWL is likely to work.
Tell the team about blood-thinning medicines, as these usually need to be paused or managed first.
Let them know if you might be pregnant — ESWL is not suitable in pregnancy.
Mention any heart pacemaker or defibrillator, an aneurysm, or untreated high blood pressure.
Take simple painkillers as advised before the session, as the treatment can be uncomfortable.
Make sure any urine infection has been treated before the procedure.
Arrange a lift home if you are having sedation, and expect to pass stone fragments over the following days.

What happens

You lie on a couch or treatment table, and the stone is pinpointed using X-ray or ultrasound. The shockwave machine is positioned against your skin over the stone.

The machine then delivers several hundred to a few thousand shockwaves, building up in strength. You will hear and feel a tapping or thumping, which can be uncomfortable, so you are given painkillers and sometimes light sedation. A session usually lasts around 45 minutes to an hour.

Afterwards you can usually go home the same day. You may see blood in your urine, and you may feel a dull ache. Over the next days to weeks, the stone fragments pass down and out in your urine, which can cause bouts of pain (renal colic). Many people need more than one session to clear a stone.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

You are, or might be, pregnant.
The stone is large, very dense or in a position where ESWL rarely works, so surgery is likely to be better.
You have an untreated urine infection or a blocked, infected kidney, which needs treating first.
You have a bleeding disorder or take blood thinners that cannot be safely managed.
The stone cannot be seen clearly enough on X-ray or ultrasound to target it.

Delay or rearrange if…

You have an active urine infection or signs of sepsis.
You might be pregnant.
Blood-thinning medicines need to be paused or managed.
Your blood pressure is high and not yet controlled.
The stone has not been properly assessed with up-to-date imaging.

Alternatives to discuss

Watchful waiting with fluids and painkillers for small stones likely to pass on their own.
Ureteroscopy — a telescope passed up to break or remove the stone.
Keyhole kidney surgery (PCNL) for large or complex stones.
Medicines to help small ureter stones pass (medical expulsive therapy) where appropriate.
Treating the underlying cause to prevent further stones.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

Painkillers only

Most people have ESWL awake, with painkillers, as the treatment is uncomfortable rather than severely painful.

Light sedation

Sometimes used for comfort; you would usually need a lift home afterwards.

Benefits

Treats many stones without surgery, cuts or a hospital stay
Usually avoids the need for a general anaesthetic
Quick recovery, with many people back to normal activity within a day or two
Can be repeated if the stone is not fully cleared
Lower-cost and lower-risk than surgery for suitable stones

Risks & complications

More common

Blood in the urine for a day or two afterwards
Pain as the broken fragments pass (renal colic), which can come in waves
Bruising or soreness of the skin where the shockwaves entered
Needing more than one session to clear the stone
The stone not breaking up enough, so another treatment is needed

Less common

Urine infection needing antibiotics
A fragment blocking the ureter and causing severe pain
Fragments getting stuck and needing a further procedure
Needing a temporary stent to keep the ureter open

Rare but serious

Bleeding around the kidney (a haematoma)
Serious infection in the bloodstream (sepsis), which can be life-threatening
Injury to nearby organs
A lasting effect on kidney function or blood pressure (uncommon and debated)

The biggest practical issues are that the stone may not clear in one session and that passing fragments can be painful. The most serious, though uncommon, risk is infection turning into sepsis, especially if there is a blocked, infected stone. Ask your urologist how likely your stone is to clear with ESWL, whether ureteroscopy might be more reliable, and what to do if you get a fever or severe pain afterwards.

Published figures to discuss

How well ESWL works depends heavily on the stone's size, density (on the scan) and distance from the skin, and on how many sessions are given. Success rates in studies vary widely, and more than one session is common, so any single figure should be read with caution.

Figure	Reported range	How to interpret it	Source / confidence
Stone clearance after treatment	Highly variable; often around 50–80% depending on stone size, density, site and number of sessions	UK and other series report a wide range; large or very dense stones (for example over ~13 mm or very high density) clear less reliably.	ESWL service review of renal stones — PMCncbi.nlm.nih.govPublished figure
Needing more than one session	Common; repeat treatment is often needed for renal stones or larger stones	Many people need a second treatment, and clearance improves with repeat sessions.	Guide sourcesClinical context
Major complications	Uncommon; serious complications are generally well under 5%, with minor colic or blood in the urine much more common	Includes significant bleeding around the kidney or serious infection; minor blood in the urine is expected, not a complication.	ESWL service review of renal stones — PMCncbi.nlm.nih.govPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no surgical wound to heal. The main part of recovery is passing the broken fragments over the following days to weeks, which can cause bouts of pain, and watching for any signs of infection or blockage.

First 24 hours

You can usually go home the same day. Expect blood in the urine and a dull ache. Drink plenty of fluids and take painkillers as advised.

First few days

Fragments begin to pass, which can cause waves of pain (renal colic). It can help to pass urine through a sieve to catch fragments for testing.

1–4 weeks

Most fragments pass over this time. A follow-up scan or X-ray may be arranged to check whether the stone has cleared.

If the stone has not cleared

A repeat ESWL session or a different treatment may be recommended. More than one session is common.

What's normal — and not a worry

Blood in the urine for a day or two
A dull ache or bruised feeling over the treated area
Bouts of pain as fragments pass
Seeing small stone pieces in the urine
Needing painkillers for a few days

Aftercare

Drink plenty of fluids to help flush out the fragments, unless told otherwise.
Take painkillers as advised for the pain of passing fragments.
Pass urine through a sieve if asked, so any fragments can be analysed.
Watch for fever, shivering or worsening pain, which can mean infection or blockage.
Take any prescribed antibiotics or stone-prevention medicines as directed.
Keep your follow-up appointment to check whether the stone has cleared.
Ask about diet and fluid changes to lower the chance of new stones.

Before your procedure

Painkillers ready at home
Sieve or strainer to catch fragments, if requested
Plenty of fluids planned
Lift home arranged if you had sedation
Follow-up scan or appointment booked
Clinic's contact number saved for severe pain or fever
Plan to discuss why the stone formed

⚠ Get urgent help if…

A high temperature, shivering or feeling very unwell (possible serious infection) — seek urgent help
Severe pain that painkillers do not control
Being unable to pass urine at all
Heavy or persistent bleeding, or large clots in the urine
Pain with vomiting and a fever, suggesting a blocked, infected kidney
Feeling faint, with a racing heart (possible sepsis)

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good result is that the stone breaks into small enough pieces to pass, and a follow-up scan shows the kidney or ureter is clear. Because more than one session is often needed, a single treatment does not always mean the stone is gone.

Clearing the stone does not stop new ones forming. A normal result tells you this stone has been treated, not that you will never get another. It is worth finding out the type of stone and what changes might reduce your future risk.

How long it lasts

ESWL treats the stone you have now; it does not prevent new stones. Many people who form one stone go on to form others, so the benefit of treatment is not permanent in that sense. Investigating why stones form, and making fluid and diet changes, can help lower the chance of more.

Related tests, treatments or support

A temporary stent is sometimes placed before or after ESWL to keep the ureter open and help fragments pass. If ESWL does not clear the stone, ureteroscopy or keyhole surgery may follow. Tests to find the cause of stones are often done alongside treatment.

Follow-up & long-term care

You will usually have a scan or X-ray a few weeks later to check whether the stone has cleared. If it has not, a repeat session or different treatment may be arranged. You may also be offered tests to find out why the stone formed and advice to reduce the risk of more.

Follow-up imaging to confirm the stone has cleared
Fluid and dietary advice to lower the risk of new stones
Tests to find the cause of stone formation, where appropriate
Ongoing review if you are a repeated stone-former

Repeat, follow-on and what comes next

A repeat ESWL session is often needed if the stone has not cleared.
If fragments get stuck or cause a blockage, a further procedure such as ureteroscopy or a stent may be needed.
New stones can form later, sometimes needing more treatment.
A follow-up scan is important, because feeling better does not always mean the stone has gone.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

Clear instructions on the warning signs of infection and blockage, and who to contact urgently.
Adequate painkillers for passing fragments, and advice on fluids.
A follow-up scan to confirm whether the stone has cleared.
A plan for repeat treatment or surgery if the stone remains.
Advice and tests to reduce the risk of future stones.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The urologist's fee and how many sessions are needed
Use of X-ray or ultrasound imaging to locate and target the stone
Whether sedation is used and the facility/treatment-room fee
Pre-treatment scans to assess the stone
Whether a stent is needed before or after treatment
Follow-up imaging to check the stone has cleared
Tests to find out why the stone formed

Make sure your written quote includes

The urologist's fee and how many sessions are covered
Imaging and assessment costs before and after treatment
Sedation fee and facility charges, if applicable
Whether a stent and its insertion/removal are included
Follow-up scan to confirm the stone has cleared
Cancellation policy
What happens — and who pays — if the stone does not clear and you need a further procedure

On the NHS? ESWL is widely available on the NHS for suitable stones; private care may be used for speed or convenience.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

How likely is ESWL to clear my stone, given its size, position and density?
Would ureteroscopy or keyhole surgery be more reliable for my stone?
How many sessions might I need?
Will I need a stent before or after the treatment?
What should I do if I get a fever or severe pain afterwards?
Why did this stone form, and how can I reduce the risk of more?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my procedure, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this procedure not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Does shockwave treatment hurt?

The treatment can be uncomfortable — you feel a tapping or thumping — so painkillers, and sometimes light sedation, are given. Passing the broken fragments afterwards can also cause bouts of pain.

Will one session clear my stone?

Not always. More than one session is commonly needed, and ESWL works less well for large, hard or awkwardly placed stones. Your urologist can give you an idea of how likely your stone is to clear.

Is it better than keyhole surgery or ureteroscopy?

It depends on the stone. ESWL avoids surgery and anaesthetic but is less reliable for large or dense stones. Ureteroscopy or keyhole surgery may clear those more reliably in one go.

How long until I pass the fragments?

Usually over days to a few weeks. Drinking plenty of fluids helps. You may be asked to sieve your urine so any fragments can be analysed.

What are the warning signs after treatment?

A fever, severe pain that painkillers do not control, or being unable to pass urine need urgent attention, as they can signal infection or a blockage.

Will it stop me getting more stones?

No. It treats the current stone but does not prevent new ones. Finding out why stones form, and changing fluids and diet, can lower your future risk.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Kidney stones treatment BAUS — Stone disease patient information NICE NG118 — Renal and ureteric stones: assessment and management ESWL service review of renal stones — PMC Predictors of ESWL success for renal calculi — PMC EAU Guidelines on Urolithiasis

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.