Extracorporeal shock wave lithotripsy

Last revised by Mostafa Elfeky on 22 Apr 2021

Extracorporeal shock wave lithotripsy (ESWL) is a common non-invasive treatment for urolithiasis, and less commonly for pancreatic or salivary ductal stones 4. It is less successful in obese patients and with stones >2 cm. Children respond equally well or better to ESWL than adults 5.

The principle of extracorporeal shock wave lithotripsy is that focused shock waves cause stone fragmentation. Repetition of this process eventually leads to pulverization of the calculi. Radiologically these can be visualized during the treatment with either fluoroscopy or ultrasound imaging. 



  • steinstrasse: incomplete fragmentation that results in a pile-up of stone fragments that obstruct the ureter
  • renal hemorrhage is rare (<1%)
  • hematuria (adult) - is common in ESWL and is considered more of a side effect from the shock waves than a complication
  • urinoma 6

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Cases and figures

  • Case 1: post ESWL calculus fragmentation
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  • Case 2: post ESWL renal hemorrhage
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  • Case 3: post ESWL subcapsular hematoma
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  • Case 4: shock wave lithotripsy-induced renal injury
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  • Case 5: steinstrasse
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