Kidney stone treatment with Non-Invasive 4th Generation ESWL.

Last updated: May 18, 2026

• Facebook
• Instagram
• WordPress
• Telegram
• WhatsApp
• LinkedIn
• Mail

Now days, every modern surgeon aims to do every operation as non-invasively as possible. In the past, kidney stones had be done by open surgery, Luckily right now we have several methods to get rid of the stone without any wound or minimizing the wound. ESWL is one option for stone management we are going to talk about. The first machine was invented in Germany after World War 2. With the benefits of shockwave sound that can infiltrate into skin without any wound, it has been developed into the 4th generation machine which does not need to be done under anaesthesia so the patient can save on unnecessary expenses in terms of the anaesthesiologist team, operative cost and hospital stay.

1st Generation ESWL

1st Generation machine is really big, being the size of around a big truck and the patient needed to be operated on under a full-filled watertank. Definitely, needed the anaesthesia within the water so everything was difficult and nearly impossible to do.

2nd Generation ESWL

That’s why 2nd generation machine was invented to solve the problem of staying in a water tank for a long time. With this generation, the first ever-dry technique, the patient tended to be more comfortable during the procedure. But the cons still exist, for example, the machine was still big, the patient was still not comfortable and needed anaesthesia due to the pain.

3rd Generation ESWL

Commonly practiced all over the world right now, the 3rd generation machine is a lot more compact, more comfortable for the patient – allowing them lie down on the bed during operation. However, anaesthesia is still needed due to some shockwave pulse possibly missing the target and causing kidney pain.

4th Generation ESWL

Royal Phnom Penh hospital is the first and currently only hospital in Cambodia that has installed this technology. Even in Thailand are still the previous 3rd generation that need to do shockwave under anaesthesia.

From the original paper from Taiwan, 4th generation machine reach 98.5% compared with 3rd generation one at 82.6% shockwave hit rate. The less missed target, the less pain patient will be experience. The pain is minimal so there is no need for any anaesthesia or even pain killers. The 12 mm of stone disappeared at 80% stone free rate within 3 months following up as reported.

With almost 2 years of experience in this machine, our success rate is 84%, 77% and 60% in < 1, 1 – 2 and > 2 cm kidney stone respectively. Strong patient satisfaction with no serious complications so far. Anyway, there are alternative management for the kidney stone and every procedure has pros and cons. The distinctive pro for 4th generation ESWL is day-care management and it is the least invasive for stone management. Is it worth to try before doing any harmful operation? Any questions you can come to visit me at the Urology clinic.

Post-ESWL patient instructions is provided here.

How the 4th Generation ESWL works? is provided here.

For kidney stone evaluation or ESWL treatment, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Frequently Asked Questions

What is 4th Generation ESWL?

4th Generation ESWL (Extracorporeal Shock Wave Lithotripsy) is the latest evolution of non-invasive kidney stone treatment. It uses focused shock waves delivered through the skin to break stones into small fragments that pass naturally in the urine. Unlike earlier generations, the 4th-generation machine achieves a 98.5% shockwave hit rate, which means less pain, no anesthesia, and no pain killers required during the procedure.

Does 4th Generation ESWL hurt or require anesthesia?

No. Because the 4th-generation machine delivers shock waves much more precisely than older 3rd-generation machines, the pulses rarely miss the target. The pain is minimal, so no anesthesia and no pain killers are needed. The patient stays awake, and the procedure is performed as day-care treatment without hospital admission.

What kidney stone sizes can be treated with ESWL?

ESWL works best for small to medium kidney stones. In our clinical experience with the 4th-generation machine, the stone-free success rates are approximately 84% for stones under 1 cm, 77% for stones 1–2 cm, and 60% for stones larger than 2 cm. For very large or complex stones, alternative treatments such as ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) may be more appropriate.

How long does it take for the stone to disappear after ESWL?

Most patients pass the stone fragments within a few days to several weeks after the procedure. Published data report that a 12 mm stone reaches 80% stone-free rate at 3 months of follow-up. Drinking plenty of water and following the post-ESWL patient instructions helps the fragments pass naturally and reduces the risk of complications.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.