Calculi are among the most common issues encountered in the urinary system with a prevalence of 1 to 20% in different countries. Aside from being a prevalent condition in itself, it also signals a number of other diseases (metabolic syndrome, bone fractures, DM, HT etc.) and has turned into a widespread costly urological disease over the course of the years, which renders it a notable condition. As the only nonsurgical treatment option, ESWL (extracorporeal shock wave lithotripsy) stands out among alternatives.

What is ESWL?

ESWL is a technique where concentrated high-energy sound waves are delivered at certain frequencies from outside the body to calculi under visual guidance of fluoroscopy and/or ultrasonography for the purpose of fragmenting it. Being the only noninvasive alternative among others, it is a notable model of treatment. 

Other Treatments of Calculous Diseases of the Urinary System

  • Medical treatment (passage of calculi with the help of medication)
  • Surgical treatment
    • Ureteroscopy-URS
    • Retrograde intrarenal surgery-RIRS
    • Percutaneous nephrolithotomy-PNL
    • Laparoscopic-robotic surgery


  • Renal calculi measuring less than 2 cm
  • Ureteral calculi (primarily calculi measuring approximately 1 cm, and also those measuring up to 2 cm)
  • Bladder calculi (in cases where there is no accompanying obstruction)
  • Pregnant women
  • Patients with uncontrolled urinary tract infection
  • Patients who are actively taking blood diluents (anticoagulant-antiaggregant) or have a condition of coagulopathy 
  • Patients who have an aortic aneurysm in close proximity of the target ESWL area
  • Patients with uncontrolled hypertension
  • Features of calculi
    • Count
    • Location
    • Composition and rigidity
  • Patient-associated variables
    • Anatomic features of kidneys and the body
    • Skin-to-calculus distance
  • Properties of the device used
  • Experience of the practitioner
  • Cooperation between the physician and patient
ESWL is a procedure that is usually tolerated quite well without causing severe pain. Regardless, a single dose intramuscular analgesic is administered beforehand so as to minimize any possible pain while preventing the patient from shifting focal point of the calculus by inhaling deeply, i.e. to increase the rate of success. Depending on preferences of the physician and the patient, ESPB (erector spinae plane block) or intravenous sedation may be selected as well.
While the patient is attending the admission process at the admission office, our physician and technician calibrate the device for use. Right after receiving a dose of analgesic, the patient is brough to the ESWL unit on floor 1, where the procedure takes place, and positioned in accordance with the location of the targeted calculus. The calculus is visualized under fluoroscopy or ultrasonography and device is focused on the lithotripsy zone. At this point, the ultrasonography gel is applied on the relevant area of the body, which eliminates pockets of air between the lithotripter and the body for maximum effect. The ESWL procedure then starts with a “click” sound. The patient continues to hear this click in short intervals and mildly feels vibration. Focal point of the calculus is frequently checked and energy level is increased in a controlled manner. The amount of energy and number of waves are adjusted in accordance with the patient’s tolerance level as well as with hardness, location and fragmenting capacity of the calculus.

Once the procedure has been completed, x-ray imaging at the ESWL unit reveals the extent to which the calculus has been fragmented. The patient is duly informed and discharged to revisit 5-7 days later for a polyclinic follow-up with ultrasonography and x-ray images. 

Aside from the admission and preliminary preparation, an ESWL session lasts approximately 50-55 minutes.
  • Intrinsic features of each patient, properties of calculi and patients’ expectations are taken into account to create a ‘tailored treatment approach’.
  • Treatment is planned and carried out by physicians specialized in all aspects of treatment of calculi at Koç University Hospital. 
  • Thanks to our highly experienced team, combined therapies involving more than one surgical technique can be performed in the same session for the most successful outcome possible. 
  • The latest ESWL technology is available at our and utilized under guidance of the most recent literature in this field. 
  • Following treatment of your calculous condition, a metabolic evaluation (urine and blood tests, calculus analysis) is conducted, diet-liquid intake plans are made to prevent/delay recurrence, and specific medical treatments are administered. 
  • The ESWL procedure is performed by physicians who concentrate specifically on treatment of calculous diseases of the urinary system. 
  • Siemens Modularis Variostar electromagnetic lithotripters are utilized in this procedure. 
  • Thanks to this cutting-edge technology, ESWL is performed more comfortably and at higher success rates.