Shockwave Lithotripsy (SWL): Is It Worth It?

 In this blog, I break down everything you need to know about shockwave lithotripsy (SWL)—how it works, who it’s right for, and what success actually looks like. From CT scan requirements to stone size, density, and placement, I cover the full AUA selection criteria, explain average success rates, and weigh the real costs involved. If you’re thinking about this treatment, this blog will help you make an informed decision.

Key Takeaways:

• SWL is non-invasive and doesn’t require anesthesia

• It only works well on stones with a density below 850 HU

• Multiple sessions are typically needed, making it expensive

• Expulsive therapy is often more cost-effective for smaller stones

Let’s talk about one of the most common kidney stone treatment options out there: shockwave lithotripsy, or SWL.

This non-invasive procedure has been around since the early 1980s and has been a go-to choice for many because it doesn’t involve surgery or anesthesia.

But over the years, its popularity has started to decline—and once you understand why, it might change how you think about your treatment options.

What Is Shockwave Lithotripsy?

Shockwave lithotripsy is exactly what it sounds like.
High-energy shock waves are aimed at your kidney stone to break it into smaller pieces.

Those smaller fragments can then pass more easily through your urinary tract.

Here’s why it became popular:

• No incisions

• No general anesthesia required

• Performed on an outpatient basis

And especially in the wake of COVID, avoiding intubation and general anesthesia has become a bigger priority for many patients.

Stone Density Matters—A Lot

But here’s the catch: SWL is only effective for certain types of stones.

To determine eligibility, your urologist will look at the stone’s density, measured in Hounsfield units (HU) on a non-contrast CT scan.

• Ideal density for SWL: Under 850 HU

• Some centers may go up to 1000 HU

• Others cap it lower, around 650 HU

If your stone is too dense—like calcium oxalate monohydrate, brushite, or certain cystine stones—SWL likely won’t work.

The Hidden Costs of Lithotripsy

Let’s talk numbers.
The average cost of one SWL session in the U.S. is about $12,000.

Now remember, most people don’t get cleared in one session.
The average number of treatments needed? Between 1.5 and 2.

So now you're looking at $24,000—and that’s after an ER visit, pain meds, CT scans, and consultations, which often rack up another $10,000.

Total potential cost? Around $30,000–$35,000.

And that’s not including what you go through passing the fragments.

Yes—You Still Have to Pass Stones

Even after SWL, you’re still passing kidney stones—just broken-up pieces.

If your stone is less dense, it might turn to powder or “sand” that passes without much discomfort.

But for higher-density stones, the result is gravel—and that means pain, frequent urination, and all the symptoms you were hoping to avoid.

**That’s why SWL is often paired with expulsive therapy to help move those fragments out faster.

You can go the medical route (with alpha blockers and side effects), or the natural route with a product like Cleanseto avoid pharmaceutical downsides.

Patient Selection Criteria: Why SWL Isn’t Always Recommended

SWL used to be a urologist’s favorite. But not anymore.

Why? Because results are inconsistent, the procedure is finicky, and the selection process is complicated.

To even be considered, you need a non-contrast CT scan. If you’ve had one in the last year, it can be reused to avoid more radiation.

What the scan tells your urologist:

• Stone size

• Stone volume

• Density (HU)

• Location in the urinary tract

• Your body’s anatomy

Once all that is considered, they’ll decide if SWL is a fit.

Common Eligibility Scenarios:

1. Stone < 10mm in ureter

   • Try expulsive therapy first (recommended by the AUA)

   • If that fails in 6 weeks, SWL is next

2. Stone < 20mm in kidney (non-lower pole)

   • SWL can be considered

3. Mid or lower ureteral stone requiring intervention

   • If it’s complicated (e.g., urine blockage or uncontrolled pain), SWL is an option

Stone Types That Do Not Respond Well to SWL:

• Calcium oxalate monohydrate

• Brushite

• Cystine (certain types)

Understanding the Kidney “Poles”

Stone location is just as important as size for SWL success.

Think of your kidney like a vertical oval:

• Upper pole

• Middle pole

• Lower pole

Lower pole stones are the hardest to treat because gravity makes them harder to pass.

That’s why many centers avoid using SWL if your stone is down there.

Real-World Success Rates of SWL

Here’s what the pooled data from multiple studies shows:

Stone-Free Rates After 12 Weeks (with expulsive therapy):

• Upper calyx: 84.4%

• Middle calyx: 86.7%

• Lower calyx: 68.5%

• Renal pelvis: 89.8%

• Upper ureter: 85.2%

So even after multiple sessions, you’re still looking at a 10–30% chance of having stones left. 

Compare That to the Cost

Let’s say your success rate is 85% and your final bill is $30,000.

If you’re like me, you’d expect a 99–100% success rate at that price.

That’s why I always recommend this:
If your stone is under 10mm, try expulsive therapy first.

• It’s backed by the American Urological Association

• It’s dramatically less expensive

• It has similar or better success rates

A Natural Alternative to $24,000+

Let’s say you use 10 bottles of a product like Cleanse. That’s about $400 total.

And studies show 90%+ success rates using expulsive therapy for stones under 10mm.

That’s hard to beat.

Final Thoughts: Be Informed Before You Decide

Shockwave lithotripsy has its place, especially for stones larger than 10mm or those that have failed expulsive therapy.

But if your stone is small, non-obstructive, and low in density, then expulsive therapy should be your first step.

It costs less.

It works well.

And you avoid a second round of pain (and debt).

Take the time to ask your urologist questions. Bring a guide. Be informed. And most importantly—take back control of your kidney stone journey.