Precautions and Contraindications for Extracorporeal Shock Wave Lithotripsy: What You Need to Know

Understanding the Risks and Precautions of Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a widely used procedure for breaking down urinary stones using high-energy shock waves. While this non-invasive treatment option offers significant benefits, it is crucial to understand the potential risks and take necessary precautions for a successful recovery.

Painkillers and Exercise:

One of the crucial aspects that patients must be aware of is the careful usage of painkillers after undergoing ESWL. Painkillers should not be taken casually as they can impact the effectiveness of the treatment. It is advised to consult the doctor and strictly follow the prescribed painkiller regimen.

To ensure optimal recovery, patients are also advised to abstain from vigorous exercise, such as running or tennis, for a day or two after ESWL. While daily activities remain unaffected, excessive physical exertion should be avoided to prevent any complications.

Adjunctive Treatment:

In order to facilitate the easy passage of the crushed stones, patients should consider complementary treatments post-ESWL. Drinking water frequently and taking alpha blockers, which relax and widen the passage of stones, can assist in the smooth removal of smaller stones.

Potential Complications:

Although rare, complications can arise during and after ESWL. Severe damage to the kidney’s blood vessels during the procedure can disrupt blood circulation and lead to permanent kidney atrophy or a significant reduction in kidney function. This highlights the importance of taking necessary precautions and following the treatment plan meticulously.


ESWL is not recommended for certain individuals. Pregnant women should avoid the procedure due to potential risks to the fetus. Additionally, patients at risk of bleeding, such as those taking anticoagulants, should temporarily discontinue medication and wait before undergoing ESWL. Those with urinary tract infections must first treat the infection before considering lithotripsy to prevent further complications.

Furthermore, individuals with urinary tract obstruction or restriction, irregular arrhythmias that cannot be controlled even with medication, or large abdominal aortic or renal artery aneurysms should refrain from ESWL to prevent potential harm.

Considering Alternative Treatments:

Director Kim Se-cheol suggests that individuals who are severely obese or find lithotripsy challenging should consider endoscopic treatment as a viable alternative. Although this method requires hospitalization and anesthesia, it has a high success rate and is increasingly being sought after by patients.

Understanding the risks, precautions, and alternative treatments associated with ESWL allows patients to make informed decisions regarding their urological treatment. Consulting with a healthcare professional is strongly advised to ensure the best possible outcomes and minimize potential complications.

There’s a reason you shouldn’t take painkillers carelessly after having ‘extracorporeal shock wave lithotripsy’, a procedure that blasts high-energy shock waves outside the body to break up ‘urinary stones’, which are n are formed on the way out of urine. .

Director Kim Se-cheol (Myeong-dong Lee Yun-soo & Cho Seong-hwan Urology), master of male medicine, has a YouTube channel called ‘I’m a doctor – After removing the stone… does it hurt when you pee?!” Side effects of removing the stone! – Nono Urology Ep.40‘ In the episode, “You shouldn’t take painkillers carelessly just because you’re sick. There are many non-steroidal anti-inflammatory painkillers,” he said. “Taking these can harm the treatment, so even if you are taking painkillers, consult your doctor and use the painkillers as prescribed.” “We need to be careful,” he explained.

As well as avoiding non-steroidal anti-inflammatory painkillers, it is best to refrain from vigorous exercise such as running or tennis for a day or two after extracorporeal shock wave lithotripsy. It does not significantly affect daily life, but excessive exercise is prohibited.

Also, after extracorporeal shock wave lithotripsy, if possible, it is advisable to provide adjunctive treatment to help the crushed stones fall out easily by drinking water frequently and taking alpha blockers that relax and widen the passage of stones from fear that there will be small stones.

Problems sometimes arise during extracorporeal shock wave lithotripsy. Director Kim Se-cheol said, “This is a story that can happen in some cases, but if the kidney’s blood vessels are severely damaged (during the procedure), blood circulation is disrupted and there are scars are formed during the healing process, leading to permanent kidney atrophy or a significant reduction in kidney function “It can cause permanent after-effects that are difficult to treat,” he says.

Some people should not have extracorporeal shock wave lithotripsy. It is a pregnant woman. Director Kim explained, “It’s dangerous for the fetus, so pregnant women shouldn’t do it.”

Even people at risk of bleeding should not undergo extracorporeal shock wave lithotripsy. A representative example is a person who takes anticoagulants such as aspirin. Director Kim Se-cheol explained, “People taking anticoagulants may bleed more often,” and added, “These patients should stop taking the medication for a while and wait before receiving treatment.”

People with urinary tract infections should also not undergo extracorporeal shock wave lithotripsy because of the risk of developing pyelonephritis or sepsis after treatment. Director Kim emphasized, “People with urinary tract infections must undergo lithotripsy treatment after treating the infection.”

Extracorporeal shock wave lithotripsy is also contraindicated in cases of urinary tract obstruction or restriction. Director Kim Se-cheol said, “If the stone is crushed, it cannot escape. Therefore, you must find out in advance whether there is a restriction or obstruction in the patient’s urinary tract and receive treatment.”

Extracorporeal shock wave lithotripsy is also contraindicated for people with irregular arrhythmias that cannot be controlled even with medication. Director Kim explained, “If there is an uncontrolled arrhythmia, a shock can worsen the arrhythmia and cause an unfortunate accident.”

People with a large aneurysm of the abdominal aorta or aneurysm of the renal artery should also not undergo extracorporeal shock wave lithotripsy because of the risk of tearing blood vessels. Patients have no health problems, but extracorporeal shock wave lithotripsy is not recommended for them.

Director Kim Se-cheol said, “People who are too obese not only have a weak shock wave effect on stones, but also have a lot of difficulties in finding stones.” He added, “Extracorporeal shock wave lithotripsy is not recommended in cases of severe obesity. ”

Director Kim said, “In addition to lithotripsy, there is also endoscopic treatment, so you can do it. Endoscopic treatment can be inconvenient because you have to be in the hospital and have anesthesia, but endoscopic treatment is also quite effective and has a high success rate, so these days, if lithotripsy seems difficult, it’s the first treatment.” “The number of endoscopy cases being sought is increasing,” he explained.

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