Should I use extracorporeal shock wave lithotripsy (ESWL) for my kidney stones?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Kidney stones can be very painful, and people often seek immediate treatment. Your choice may be between letting the stone exit your body (pass) on its own and using pain medicine, or breaking up the stone to speed it along and lessen the pain. Consider the following when making your decision:

• The size of your stone and its likelihood of passing on its own help determine the type of treatment. The American Urological Association (AUA) recommends the following if your stone is not made of cystine or uric acid, you have not had a stone before, and you are otherwise healthy:¹
  • If the stone will probably pass and you can control your pain with medicine, home treatment may be enough. The smaller a stone is, the more likely it is to pass on its own. About 9 out of every 10 stones smaller than and about 5 out of every 10 stones to pass on their own.² Only 1 or 2 out of every 10 kidney stones need more than home treatment.²
  • If the stone probably will not pass, talk with your doctor about all your treatment options.
• If you cannot control your pain with medicine, or if the stone is blocking the urine flow, your best choice may be ESWL. ESWL may work best for kidney stones that are still located in the kidney. It may be harder to break up a stone that has moved into the ureter, although this is still possible. You have options other than ESWL, but it is the most commonly used method because it is effective and does not require any surgery.
• You usually do not have ESWL if you are pregnant or have a bleeding disorder, kidney infection, urinary tract infection, kidney cancer, or kidneys with abnormal structure or function.

Medical Information

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What are kidney stones?

Kidney stones (renal calculi or nephrolithiasis) are pieces of minerals that form in the kidneys. They form when the normal balance of water, salts, minerals, and other substances found in your urine changes. How this balance changes determines the type of kidney stones you get. Most kidney stones are calcium-type—they form when the calcium levels in your urine change.

Kidney stones may remain in the kidney or travel out of the body through the urinary tract —the tubes that connect the kidney to the bladder (ureters) and lead outside the body (urethra). When traveling through the urinary tract, a stone may cause no pain or cause great pain and other symptoms. Kidney stones can cause long-term damage to the urinary tract if they continue to grow in size or if they block the flow of urine from the kidneys.

What is ESWL?

Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break the kidney stone into small pieces that can pass from the body more easily than one large stone. Stone fragments usually pass within a few weeks. Depending on the size of the stone, you may need only one treatment. The larger the stone, the more likely it is that you will need more than one treatment.

See an illustration of ESWL .

ESWL is only one method used to break up kidney stones, but it is the most commonly used method because it does not require surgery. Other options include percutaneous nephrolithotomy or nephrolithotripsy, ureteroscopy, and open surgery.

What are the risks of ESWL?

ESWL has few complications. Complications may include:

• Pain caused by the passage of stone fragments. This is the most common side effect.
• Blocked urine flow as a result of stone fragments becoming stuck in the urinary tract. The fragments may then need to be removed with a ureteroscope.
• Urinary tract infection.
• Bleeding around the outside of the kidney.

What are the risks of not using ESWL to treat kidney stones?

Unless the kidney stone is blocking urine flow or you have a urinary tract infection, the risks of not using ESWL or another method to break up the stone are small.

If you need more information, see the topic Kidney Stones.

Your Information

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Your choices are:

• Wait for the stone to pass while using medicine to control the pain. Your doctor may also prescribe a medicine to help the stone pass, such as a calcium channel blocker.
• Use ESWL to break up the stone in the hope that the pieces of stone pass more quickly with less pain.
• Use another option, such as percutaneous nephrolithotomy or nephrolithotripsy, ureteroscopy, or open surgery.

The decision about whether to use ESWL takes into account your personal feelings and the medical facts.

Extracorporeal shock wave lithotripsy (ESWL) for kidney stones

Reasons to use ESWL

Reasons not to use ESWL

The stone is not passing on its own and is causing pain that will not go away. The stone is completely blocking the urine flow. You have only one working kidney, and your doctor worries that the stone is affecting that kidney's ability to function. The stone is causing serious bleeding. The stone continues to grow. You have had a kidney transplant, and your doctor worries about damage from a stone. Are there other reasons you might want to use ESWL?

You are pregnant. You have a bleeding disorder. You have a kidney infection, urinary tract infection, or kidney cancer. You have kidneys with abnormal structure or function. You may need more than one treatment to break up a stone. The larger the stone, the more likely it is that you will need multiple treatments. You have a cystine kidney stone, which does not break up easily. You take blood thinners (anticoagulants), and your medication cannot be stopped to perform the procedure. Are there other reasons you might not want to use ESWL?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using ESWL to treat your kidney stones. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am tolerating the pain.	Yes	No	Unsure
The pain medicine is working well enough that I can wait for the stone to pass.	Yes	No	Unsure
I'm concerned about how long it might take the stone to pass, based on how large it is.	Yes	No	Unsure
I'm concerned about the risks of the ESWL procedure.	Yes	No	Unsure
I'd rather wait and see whether the stone passes and then reconsider my decision if it's taking too long or causing too much pain.	Yes	No	Unsure
I am concerned about the cost of ESWL.	Yes	No	NA*
I am concerned about lost work time.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use ESWL.

Check the box below that represents your overall impression about your decision.

Leaning toward using ESWL

Leaning toward NOT using ESWL

Return to the topic:

• Acute Renal Failure
• Kidney Stones

References

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Citations

1. American Urological Association Ureteral Stones Clinical Guidelines Panel (1997). Report on the management of ureteral calculi. Clinical Practice Guidelines. Baltimore, MD: American Urological Association. Also available online: http://www.auanet.org/timssnet/products/guidelines/main_reports/UreStnMain8_16.pdf.

2. Parmar MS (2004). Kidney stones. BMJ, 328(7453): 1420–1424.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Specialist Medical Reviewer	Philip Belitsky, MD, FRCSC - Urology
Last Updated	May 30, 2007