What Is Lithotripsy for Kidney Stones?

Some kidney stones pass on their own. Others don't — they lodge in the ureter, the narrow tube between kidney and bladder, and sit there causing pain while urine struggles to get past. When a stone is too big or too stubborn to pass, one option is to break it into pieces small enough to leave the body naturally. That breaking-up is lithotripsy, and it can be done two ways: with shock waves aimed from outside the body, or with laser energy delivered from inside, through a thin scope.

Step one: finding and sizing the stone

Treatment starts with imaging, usually a scan that shows exactly where the stone is, how large it is, and whether it's blocking urine flow. Size and position drive everything that follows. A stone sitting in the kidney may suit shock-wave treatment, while one stuck partway down the ureter often calls for the scope-and-laser route instead. Your urologist will also check how you're feeling overall — ongoing blockage and infection change the urgency, so the plan isn't based on the stone alone.

Step two: breaking the stone from outside — shock waves

Extracorporeal shock wave lithotripsy — ESWL for short — needs no incision and no scope inside you. You lie on a treatment table while a machine generates focused shock waves outside the body and aims them, using imaging, at the stone. The waves pass through the skin and concentrate their energy on the stone itself, cracking it into smaller fragments over the course of the session. This site's video "Extracorporeal shockwave lithotripsy" (about a minute and a half) walks through that idea: break the stone down, then let the fragments travel out through the urinary tract on their own.

Step three: breaking it from inside — scope and laser

The other route works from within. Under anaesthesia, the surgeon passes a slim telescope called a ureteroscope through the natural urinary passage and up the ureter until the stone is in view on the monitor. A fine laser fibre then sits alongside the scope, and pulses of holmium laser energy are fired directly at the stone, chipping and dusting it into fragments that can wash out or be lifted away. The video at the top of this page follows exactly that approach — "Ureteroscopy and Intracorporeal Lithotripsy (Using Holmium Laser)" (about 4 minutes) — and its own description notes the case it shows: a ureteral stone being treated this way after shock-wave treatment hadn't cleared it. Sometimes a soft temporary tube called a stent is left in the ureter afterwards to keep urine draining while any swelling settles.

Step four: passing the pieces and checking the result

Whichever route was used, the job isn't quite finished when the stone breaks. The fragments still have to travel down and out, which can take days and sometimes brings brief twinges as pieces pass. You may be asked to drink well, to strain your urine to catch a fragment for analysis, and to come back for follow-up imaging to confirm the stone has cleared. Knowing what a stone is made of helps with preventing the next one — and if stones are new to you, our guide to what a kidney stone is and how it is treated covers the wider picture, from symptoms to the other treatment options.

Frequently Asked Questions

Does lithotripsy involve any cuts?

No incisions are made in either main route. Shock-wave lithotripsy works entirely from outside the body, and laser lithotripsy reaches the stone through the natural urinary passage with a thin scope.

Which type will I be offered?

It depends mainly on the stone's size and position, and on how you're doing overall. Stones in the kidney often suit shock waves, while stones stuck in the ureter are commonly treated with the scope-and-laser approach — your urologist will explain the reasoning in your case.

Will I be asleep during it?

Shock-wave sessions are often done with sedation or anaesthesia so you stay still and comfortable. Ureteroscopy with laser lithotripsy is usually done under general anaesthesia. Your team will confirm the plan beforehand.

What happens after the fragments pass?

Follow-up usually includes imaging to check the stone has cleared, and sometimes analysis of a caught fragment. If a stent was placed, you'll be told when and how it will be removed.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about lithotripsy, not medical advice and not a diagnosis. Kidney-stone pain with fever, vomiting, or being unable to pass urine needs prompt, urgent medical care.