{"id":3217,"date":"2021-06-18T08:00:00","date_gmt":"2021-06-18T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=3217"},"modified":"2026-05-18T09:56:58","modified_gmt":"2026-05-18T02:56:58","slug":"eswl-how-the-4th-generation-%e1%9e%92%e1%9f%92%e1%9e%9c%e1%9e%be%e1%9e%80%e1%9e%b6%e1%9e%9a","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/km\/2021\/06\/18\/eswl-how-the-4th-generation-works\/","title":{"rendered":"\u178f\u17be\u1798\u17c9\u17b6\u179f\u17ca\u17b8\u1793\u1794\u17c6\u1794\u17c2\u1780\u1782\u17d2\u179a\u17bd\u179f\u178f\u1798\u17d2\u179a\u1784\u1793\u17c4\u1798\u1787\u17c6\u1793\u17b6\u1793\u17cb\u1791\u17b8 \u17e4 \u1798\u17b6\u1793\u1794\u17d2\u179a\u179f\u17b7\u1791\u17d2\u1792\u17b7\u1797\u17b6\u1796\u1793\u17b9\u1784\u179c\u17b6\u178a\u17c6\u178e\u17be\u179a\u1780\u17b6\u179a\u1794\u17b6\u1789\u1794\u17c6\u1794\u17c2\u1780\u1782\u17d2\u179a\u17bd\u179f\u178f\u17b6\u1798\u179a\u1794\u17c0\u1794\u1799\u17c9\u17b6\u1784\u178e\u17b6?"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/new-photo-2024\/\" 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2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Extracorporeal Shockwave Lithotripsy (ESWL) is a minimally invasive procedure for kidney stones. This article focuses on the 4th Generation ESWL, the most advanced technology currently available. For <a href=\"https:\/\/drsoaraweeurology.com\/2021\/03\/19\/post-eswl-patient-instructions\/\">post-ESWL patient instructions<\/a> and the <a href=\"https:\/\/drsoaraweeurology.com\/2020\/05\/02\/urology-soarawee-thai-urologist\/\">history of all 4 ESWL generations<\/a>, see the linked articles.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand\u00a0<a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a>\u00a0<a href=\"tel:02-310-3009\">02-310-3009<\/a>\u00a0<a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi&nbsp;<a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<span class=\"embed-youtube\" style=\"text-align:center; display: block;\"><iframe class=\"youtube-player\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/8Ddq-QhEaNY?version=3&#038;rel=1&#038;showsearch=0&#038;showinfo=1&#038;iv_load_policy=1&#038;fs=1&#038;hl=km&#038;autohide=2&#038;wmode=transparent\" allowfullscreen=\"true\" style=\"border:0;\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation allow-popups-to-escape-sandbox\"><\/iframe><\/span>\n<\/div><figcaption class=\"wp-element-caption\">Patient testimonial: Kidney stone treatment with 4th Generation ESWL at Bangkok Hospital.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">How does <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560887\/\">ESWL<\/a> work?<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ESWL technology originated as an incidental breakthrough during World War 2 and has been refined through 4 generations. Each generation offers better pain control and fewer complications<\/li>\n\n\n<li>The shockwave head is placed against the patient&#8217;s flank (the area where the kidney lies). The machine generates shockwave pulses that travel through the skin and break kidney stones into small fragments<\/li>\n\n\n<li>Once fragmented, the natural continuous flow of urine from the kidney flushes the stone fragments out through normal urination<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"3237\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/06\/18\/eswl-how-the-4th-generation-works\/4th-gen-eswl-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"4th Generation Extracorporeal Shockwave Lithotripsy is currently function at Royal Phnom Penh hospital, Cambodia.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;4th Generation Extracorporeal Shockwave Lithotripsy is currently function at Royal Phnom Penh hospital, Cambodia.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?resize=800%2C533&#038;ssl=1\" alt=\"4th Generation ESWL machine Bangkok Hospital\" class=\"wp-image-3237\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/4th-Gen-ESWL-2.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">4th Generation ESWL is available at Bangkok Hospital Headquarters.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Advantages of 4th Generation ESWL over previous generations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Auto-tracking system<\/strong> \u2014 The 4th Generation machine uses an automated targeting system that continuously tracks and locks onto the stone like a precision targeting system. This ensures shockwaves hit the stone accurately, minimizing unnecessary energy delivery to surrounding kidney tissue<\/li>\n\n\n<li><strong>Day-care procedure without anesthesia<\/strong> \u2014 Minimized perioperative pain means the procedure is completed as a day-care (outpatient) treatment, requiring only 3 hours total, with no anesthesia team needed. This reduces medical costs and eliminates post-anesthetic recovery time<\/li>\n\n\n<li><strong>Higher accuracy rate<\/strong> \u2014 98.5% hit rate for the 4th Generation vs. 82.6% for 3rd Generation machines<\/li>\n\n\n<li><strong>Fewer complications<\/strong> \u2014 Higher targeting precision means less trauma to surrounding renal tissue<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"3238\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/06\/18\/eswl-how-the-4th-generation-works\/eau-eswl\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Auto-tracking system is the strong point of this latest Generation ESWL application.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Auto-tracking system is the strong point of this latest Generation ESWL application.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?resize=800%2C533&#038;ssl=1\" alt=\"4th Generation ESWL auto-tracking system\" class=\"wp-image-3238\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/06\/EAU-ESWL.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">The auto-tracking system is the key clinical advantage of 4th Generation ESWL.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Success rates of 4th Generation ESWL (Bangkok Hospital data)<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The European Association of Urology (EAU) 2020 guidelines recommend ESWL for kidney stones under 2 cm. Success is defined as stone fragments &lt; 4 mm on follow-up imaging.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Stone &lt; 1 cm:<\/strong> 84% success rate<\/li>\n\n\n<li><strong>Stone 1\u20132 cm:<\/strong> 77% success rate<\/li>\n\n\n<li><strong>Stone &gt; 2 cm:<\/strong> 60% success rate<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<span class=\"embed-youtube\" style=\"text-align:center; display: block;\"><iframe class=\"youtube-player\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/u7435inpFdU?version=3&#038;rel=1&#038;showsearch=0&#038;showinfo=1&#038;iv_load_policy=1&#038;fs=1&#038;hl=km&#038;autohide=2&#038;wmode=transparent\" allowfullscreen=\"true\" style=\"border:0;\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation allow-popups-to-escape-sandbox\"><\/iframe><\/span>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">For any questions about ESWL, discuss with your trusted urologist or contact me through the social links on this website.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About 4th Generation ESWL<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What makes 4th Generation ESWL better than previous generations?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The defining advantage of 4th Generation ESWL is its auto-tracking system, which continuously locks onto the kidney stone and delivers shockwaves with 98.5% targeting accuracy (compared to 82.6% in 3rd Generation machines). This precision reduces energy delivery to surrounding tissue, minimizes pain, and allows the procedure to be performed as a day-care outpatient treatment without anesthesia. The total procedure time is approximately 3 hours with no hospitalization required.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What size kidney stones can ESWL treat?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The European Association of Urology (EAU) guidelines recommend ESWL for kidney stones under 2 cm. At Bangkok Hospital Headquarters, our 4th Generation ESWL data shows: 84% success for stones under 1 cm, 77% for 1\u20132 cm stones, and 60% for stones over 2 cm. Success is defined as residual stone fragments under 4 mm at follow-up. Stones larger than 2 cm may require additional sessions or alternative procedures such as ureteroscopy or percutaneous nephrolithotomy (PCNL).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is ESWL painful and is anesthesia required?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">With 4th Generation ESWL, the procedure is well-tolerated and does not require general anesthesia. The auto-tracking technology minimizes unintended shockwave delivery to surrounding tissue, significantly reducing perioperative pain compared to older generations. The procedure is completed as a day-care outpatient treatment in approximately 3 hours. Patients can typically return home the same day without post-anesthetic recovery concerns.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you have been diagnosed with kidney stones and would like to discuss ESWL or other kidney stone treatment options, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Book a Consultation<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> 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.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@type\": \"FAQPage\",\n  \"mainEntity\": [\n    {\n      \"@type\": \"Question\",\n      \"name\": \"What makes 4th Generation ESWL better than previous generations?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Auto-tracking system with 98.5% targeting accuracy (vs 82.6% in 3rd Gen). Reduces pain, no anesthesia required, day-care outpatient procedure in ~3 hours, fewer complications from reduced surrounding tissue trauma.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"What size kidney stones can ESWL treat?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"EAU recommends ESWL for stones <2 cm. Bangkok Hospital 4th Gen data: 84% success <1 cm, 77% for 1-2 cm, 60% for >2 cm. Success = fragments <4 mm at follow-up.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Is ESWL painful and is anesthesia required?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"4th Generation ESWL does not require general anesthesia. Auto-tracking minimizes shockwave delivery to surrounding tissue, reducing pain. Day-care outpatient treatment ~3 hours. Patients return home same day.\"\n      }\n    }\n  ]\n}\n<\/script>\n\n\n\n<h3 class=\"has-text-align-center wp-block-heading\">Testimonials<\/h3>\n","protected":false},"excerpt":{"rendered":"<p>Extracorporeal Shockwave Lithotripsy (ESWL) is a minimally invasive procedure for kidney stones. This article focuses on the 4th Generation ESWL, the most advanced technology currently available. For post-ESWL patient instructions and the history of all 4 ESWL generations, see the linked articles. How does ESWL work? Advantages of 4th Generation ESWL over previous generations Success [&hellip;]<\/p>\n","protected":false},"author":185281453,"featured_media":10009,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"4th Generation ESWL for kidney stones: auto-tracking system, 98.5% accuracy, day-care procedure without anesthesia, and success rates by stone size. 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