Extracorporeal shock wave lithotripsy (ESWL): Your expert guide

Written by: Mr Ahmed Riaz
Edited by: Sophie Kennedy

Extracorporeal shock wave lithotripsy, or ESWL, is a safe and effective treatment for certain types of kidney and ureteral stones. It offers a non-invasive approach to stone removal with high success rates and minimal downtime. In this informative article, highly esteemed consultant urologist Mr Ahmed A Riaz reveals what ESWL treatment entails, including its advantages and associated risks. The revered specialist also shares his expert insight on the key steps to follow after undergoing ESWL to ensure a good recovery.

What is ESWL?

Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive medical procedure used to treat certain kidney and ureteral stones. It employs shock waves to break down kidney stones into smaller fragments, making them easier to pass through the urinary tract naturally. ESWL is a preferred treatment option for smaller stones and can often be performed on an outpatient basis.

Why is ESWL performed?

ESWL is commonly used to treat kidney and ureteral stones that are:

  • Less than 2 cm in diameter (larger stones may require alternative treatments) 
  • Located in the kidney or upper ureter (stones in the lower ureter or bladder might require different approaches)
  • Causing symptoms such as severe pain, blockage of urine flow, or recurrent urinary tract infections

How is ESWL performed?


Before the procedure, you may be asked to fast for a few hours, and you might receive medications to help you relax or minimise discomfort during the procedure.


You will lie down on a cushioned table, and the medical team will position you in a way that allows the shock waves to target the kidney or ureter stone accurately.

Ultrasound or X-ray

The medical team will use either an ultrasound or an X-ray machine to precisely locate the stone.

Shock wave application

Once the stone's location is determined, a device outside the body generates shock waves that break the stone into smaller pieces. The shock waves pass through the body, focusing on the stone and breaking it into smaller pieces.


After the procedure, you will be monitored. If the stone is broken into small fragments, they will be passed out of the body through urine over the following days or weeks.

Advantages of ESWL


ESWL does not require surgical incisions, leading to less risk and shorter recovery times compared to other stone removal methods.

Outpatient procedure

ESWL can be performed on an outpatient basis in most cases, allowing you to return home the same day.

High success rates

ESWL has proven effective in treating many kidney and ureteral stones, especially smaller ones.

Risks and considerations

While ESWL is generally safe, potential risks and considerations include:

  • Bruising or soreness on the back or abdomen
  • Blood in the urine
  • Incomplete stone fragmentation, necessitating further treatment
  • Rarely, damage to surrounding organs or tissues.

Your practitioner will discuss the potential risks and benefits of ESWL with you and determine if it is the most suitable treatment for your condition.


Following these steps will help to ensure you make a good recovery.

  1. Stay hydrated - Drinking plenty of water can aid in flushing out the stone fragments from your urinary tract.
  2. Follow instructions - Your doctor will provide specific post-procedure guidelines that you should follow carefully.
  3. Follow-up - Attend all scheduled follow-up appointments to monitor your progress and ensure the successful passage of stone fragments.

If you are suffering from symptoms associated with kidney or ureteral stones and wish to schedule a consultation with Mr Riaz, you can do so by visiting his Top Doctors profile.

By Mr Ahmed Riaz

Mr Ahmed Riaz is an esteemed consultant urologist based in West Yorkshire with over 20 years of experience. His expertise spans a wide range of urological conditions, including prostate issues, lower urinary tract symptoms, kidney stones, erectile problems, bladder symptoms, and urinary tract infections. In particular, he specialises in the non-surgical treatment of kidney stones, including shockwave treatment.

Mr Riaz qualified in medicine from Sindh Medical College in Karachi, Pakistan in 2002. He went on to achieve membership of the Royal College of Surgeons in Dublin in 2008 and in 2014, became a fellow in urology of the Royal College of Surgeons in London. In 2016, Mr Riaz was appointed as a fellow of the European Board of Urology. He has amassed a wealth of clinical experience throughout his career as a consultant urologist at Huddersfield Royal Infirmary, the Princess Alexandra Hospital and most recently Chesterfield Royal Hospital, his present NHS base. He sees patients in private practice at the Urology Clinic in Batley, West Yorkshire.

Additional to his clinical responsibilities, Mr Riaz is actively involved in research and academic pursuits and has presented internationally on his areas of expertise. He has published a number of academic papers and has also designed and created various highly specialist models, simulators and devices for use in instruction and clinical practice to improve outcomes. Mr Riaz is also is actively involved in teaching and mentoring future medical professionals.

Mr Riaz's commitment to patient care and continuous improvement throughout his career has been recognised with various awards, including the Applause Badge at Chesterfield Royal Hospital, and a nomination for the Medipex Innovation Award for his groundbreaking work on a non-cuffing urinary catheter device. He has also been involved in various voluntary projects in Pakistan, leading emergency response teams and providing medical aid and expert urological care to patients in need. 

Mr Riaz is passionate about ensuring excellent quality healthcare is available to all. As such, rather than offering his services at fixed prices, he offers patients the opportunity to pay what they can afford towards clinic fees and only looks to cover costs for tests required to provide a diagnosis. He does not offer surgery in private practice and rather centres his work around short clinics for diagnosis and second opinions at an affordable price.

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