{"id":10181,"date":"2026-05-06T20:00:00","date_gmt":"2026-05-06T13:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=10181"},"modified":"2026-08-17T00:18:58","modified_gmt":"2026-08-16T17:18:58","slug":"%e1%80%80%e1%80%bb%e1%80%b1%e1%80%ac%e1%80%80%e1%80%ba%e1%80%80%e1%80%95%e1%80%ba-%e1%80%80%e1%80%bb%e1%80%b1%e1%80%ac%e1%80%80%e1%80%ba%e1%80%81%e1%80%bd%e1%80%b2-%e1%80%85%e1%80%94%e1%80%85%e1%80%ba","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/","title":{"rendered":"\u1000\u103b\u1031\u102c\u1000\u103a\u1000\u1015\u103a\u101b\u1031\u102c\u1002\u102b\u1000\u102f\u101e\u101b\u1031\u1038\u104f \u1006\u1004\u1037\u103a\u1000\u1032\u1010\u102d\u102f\u1038\u1010\u1000\u103a\u1019\u103e\u102f- \u1005\u1005\u103a\u1012\u1031\u101e\u1019\u103b\u102c\u1038\u1019\u103e \u1001\u1031\u1010\u103a\u1019\u102e\u1014\u100a\u103a\u1038\u1015\u100a\u102c\u1016\u103c\u1004\u1037\u103a \u1000\u102f\u101e\u1001\u103c\u1004\u103a\u1038\u1021\u1011\u102d"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-e269d6e6 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\/my\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" 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;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=12%2C12&amp;ssl=1 12w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=600%2C600&amp;ssl=1 600w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=400%2C400&amp;ssl=1 400w, 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onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M12 0C5.372 0 0 5.372 0 12s5.372 12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 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\">Welcome to a journey through the history and science of one of the most transformative technologies in modern urology: <strong>Extracorporeal Shockwave Lithotripsy (ESWL)<\/strong>. As a board-certified urologist specializing in kidney stone treatment, I want to share with you how a wartime observation evolved into one of the most elegant non-invasive procedures we offer today.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This article is drawn from my official presentation delivered at the <strong>Royal Phnom Penh Urology Seminar on November 17, 2018<\/strong>. That seminar remains a meaningful milestone in my career \u2014 a moment where we connected the historical roots of medical innovation to the cutting-edge solutions I now provide to patients at Bangkok Hospital Headquarters and Samitivej Sriracha Hospital.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"600\" data-attachment-id=\"10249\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/the-evolution-of-stone-treatment-6-things-to-know-about-eswl\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?fit=800%2C600&amp;ssl=1\" data-orig-size=\"800,600\" 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=\"The Evolution of Stone Treatment \u2014 6 Things to Know About ESWL | Visual Summary by Dr. Soarawee\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;The Evolution of Stone Treatment \u2014 6 things you should know about ESWL&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?fit=800%2C600&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?resize=800%2C600&#038;ssl=1\" alt=\"Visual summary infographic by Dr. Soarawee Weerasopone \u2014 6 things to know about the evolution of Extracorporeal Shockwave Lithotripsy (ESWL), from WWII shockwave observations through four generations of lithotripters to fourth-generation ultrasound tracking; ESWL at Bangkok Hospital Headquarters is performed with a third-generation lithotripter\" class=\"wp-image-10249\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?resize=300%2C225&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?resize=768%2C576&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment-6-Things-to-Know-About-ESWL.jpg?resize=16%2C12&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">The Evolution of Stone Treatment \u2014 6 things you should know about ESWL<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Before the History: When a Stone Becomes an Emergency<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This article is about technology, and technology is the least urgent part of stone disease. Before reading on, it is worth knowing which stone situations cannot wait, because the answer to them is not a lithotripter appointment:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fever or shaking chills with flank pain.<\/strong> This suggests an infected, obstructed kidney \u2014 the true emergency of stone disease. It needs urgent drainage of the kidney, not antibiotics alone, and it can become life-threatening within hours.<\/li>\n\n\n\n<li><strong>Passing little or no urine<\/strong>, or severe pain in a man with a single functioning kidney or a transplanted kidney.<\/li>\n\n\n\n<li><strong>Pain with persistent vomiting<\/strong> that prevents you keeping fluids down.<\/li>\n\n\n\n<li><strong>Suspected stone in pregnancy<\/strong>, which needs assessment by a team rather than a standard pathway.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In Thailand the emergency number is 1669. Everything below assumes you are not in one of these situations.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Exactly is a Shockwave?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">To understand how we break kidney stones without a single incision, we must first understand the physics of the shockwave. In scientific terms, a shockwave is a <strong>sharp change of pressure in a narrow region traveling through a medium<\/strong> such as air or water. These waves are typically caused by explosions or by bodies moving faster than the speed of sound.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In urology, we harness this energy and aim it with precision. Think of it like a focused beam of sound energy: much like a magnifying glass focuses sunlight onto a single point to create heat, an ESWL machine focuses shockwaves onto a kidney stone to create mechanical stress, eventually shattering the stone into dust or small fragments that can be passed naturally in the urine.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">A Surprising History: From Battlefields to Hospitals<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The history of ESWL is a classic example of <em>dual-use technology<\/em> \u2014 where a discovery in one field changes another entirely.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>The World War II Connection:<\/strong> During WWII, it was observed that sailors and soldiers in the vicinity of underwater depth charge explosions suffered severe lung injuries \u2014 even when they had no visible external wounds. This proved that shockwaves could travel through water and the human body to affect internal structures.<\/li>\n\n\n\n<li><strong>The Breakthrough (1980):<\/strong> Decades of research into high-energy physics eventually led to a medical breakthrough. On <strong>February 7, 1980<\/strong>, the very first human treatment using a first-generation Extracorporeal Shockwave Lithotripter was performed in Germany. This single event changed urology forever, transforming what used to be major open surgeries into non-invasive procedures.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"10190\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/this-picture-show-how-prof-christian-chaussy-operated-his-first-patient-he-put-his-patient-into-1-eswl-water-fill-tank\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.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=\"First ESWL Treatment by Prof. Christian Chaussy in Water Bath \u2014 History of Kidney Stone Treatment\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Prof. Christian Chaussy performing the world's first ESWL kidney stone treatment in 1980 \u2014 patient submerged in a water-filled tank, the original first-generation Extracorporeal Shockwave Lithotripsy procedure in Munich, Germany\" class=\"wp-image-10190\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-picture-show-how-Prof.-Christian-Chaussy-operated-his-first-patient.-He-put-his-patient-into-1-ESWL-water-fill-tank.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Prof. Christian Chaussy treating the world\u2019s first ESWL patient in 1980 \u2014 the patient is submerged in the original water-filled tank lithotripter.<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"10189\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/prof-christian-chaussy-egbert-schmiedt-and-1-eswl-patient-hans-dworsak\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.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=\"Prof. Christian Chaussy, Egbert Schmiedt and First ESWL Patient Hans Dworsak \u2014 Birth of Lithotripsy 1980\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Historic photograph of Prof. Christian Chaussy, Prof. Egbert Schmiedt and Hans Dworsak \u2014 the world's first patient treated with Extracorporeal Shockwave Lithotripsy (ESWL) in Munich, Germany, February 1980\" class=\"wp-image-10189\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Prof.-Christian-Chaussy-Egbert-Schmiedt-and-1-ESWL-patient-Hans-Dworsak.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Prof. Christian Chaussy, Prof. Egbert Schmiedt, and Hans Dworsak \u2014 the world\u2019s first ESWL patient (Munich, February 1980).<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The Four Generations of ESWL<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The technology has evolved rapidly since 1980. Each generation of machines has aimed to make the treatment <strong>safer, more comfortable, and more accurate<\/strong>. One caution before the list, because it is easy to read a story of generations as a story of steadily better results: what improved most across the generations was comfort, size, cost and targeting. Stone clearance itself has not improved in the same straight line, and the characteristics of your stone matter more than the age of the machine.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1. <a href=\"https:\/\/www.americanjournalofsurgery.com\/article\/0002-9610(89)90569-2\/abstract\" target=\"_blank\" rel=\"noreferrer noopener\">The First Generation: The Water Bath Era<\/a><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The early machines were massive. To work, the patient had to be submerged in a large tub of water to allow the shockwaves to travel from the generator into the body. The downsides were significant: these machines were incredibly expensive and huge, the focal zone (the area where the energy hits) was wide and therefore less precise, patients required general anesthesia, and they typically required hospitalization.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"10188\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/picture-of-1-generation-eswl-thats-very-big-and-need-specialized-urologist-and-technician-only-function-in-high-volumed-excellent-center\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.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=\"First-Generation ESWL Machine \u2014 Large Lithotripter for Kidney Stones\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?resize=800%2C533&#038;ssl=1\" alt=\"First-generation Extracorporeal Shockwave Lithotripsy (ESWL) machine \u2014 a large, expensive lithotripter requiring specialized urologists and technicians, originally found only in high-volume tertiary kidney stone treatment centers\" class=\"wp-image-10188\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-of-1-generation-ESWL-thats-very-big-and-need-Specialized-urologist-and-Technician-Only-function-in-High-volumed-Excellent-center.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">The first-generation ESWL machine \u2014 a large, expensive lithotripter found only in specialized high-volume kidney stone treatment centers.<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"10187\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/picture-described-how-to-facilitate-the-1-eswl-machine\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.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=\"How First-Generation ESWL Machine Works \u2014 Water Bath Lithotripsy Diagram\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Technical diagram showing how the first-generation ESWL machine operates \u2014 patient submerged in a water-filled tank with the shockwave generator targeting the kidney stone, the original 1980 lithotripsy setup\" class=\"wp-image-10187\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/Picture-described-how-to-facilitate-the-1-ESWL-machine.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">How the first-generation ESWL machine works \u2014 the patient is submerged in a water-filled tank while the shockwave generator targets the kidney stone.<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">2. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/1507329\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Second Generation: The Dry Patient<\/a><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Engineers replaced the giant water tub with a small water-filled cushion or bellows pressed against the patient\u2019s skin. The patient stayed dry, and the focal zone became tighter and more accurate. Some treatments could be done under local anesthesia \u2014 but the machines remained large and still required significant radiation exposure for stone targeting.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"10185\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/this-is-the-picture-of-2-generation-eswl-smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" 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=\"Second-Generation ESWL Machine \u2014 Dry Patient Lithotripter for Kidney Stones\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?resize=800%2C800&#038;ssl=1\" alt=\"Second-generation Extracorporeal Shockwave Lithotripsy (ESWL) machine \u2014 smaller, more compact lithotripter using a water-filled cushion against the patient's skin, eliminating the need for a full water-filled tank\" class=\"wp-image-10185\" style=\"width:500px\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-2-generation-ESWL-Smaller-machine-and-no-need-for-patient-to-be-placed-in-water-filled-tank.jpg?resize=12%2C12&amp;ssl=1 12w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Second-generation ESWL \u2014 a smaller machine using a water-filled cushion against the patient\u2019s skin instead of a full water tank.<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">3. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3319085\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Third Generation: Compact Efficiency<\/a><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">These machines became much smaller and more mobile. However, they still relied heavily on X-ray (fluoroscopy) for targeting, meaning patients were exposed to radiation. Furthermore, the patient\u2019s breathing caused the kidney stone to move up and down with each respiration, making it difficult to maintain a perfect hit rate on the stone. This is the generation in use at Bangkok Hospital Headquarters today, and it remains a thoroughly established treatment \u2014 the large majority of the world\u2019s published ESWL evidence was generated on machines of this type.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"10186\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/this-is-the-picture-of-3-generation-eswl\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" 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=\"Third-Generation ESWL Machine \u2014 Compact Mobile Lithotripter for Kidney Stones\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?resize=800%2C800&#038;ssl=1\" alt=\"Third-generation Extracorporeal Shockwave Lithotripsy (ESWL) machine \u2014 compact and mobile lithotripter with X-ray fluoroscopy targeting, used in modern kidney stone treatment before the introduction of fourth-generation respiratory tracking systems\" class=\"wp-image-10186\" style=\"width:500px\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?resize=768%2C768&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/This-is-the-picture-of-3-generation-ESWL.jpg?resize=12%2C12&amp;ssl=1 12w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Third-generation ESWL \u2014 a compact, mobile lithotripter with X-ray fluoroscopy targeting.<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">4. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3319085\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Fourth Generation<\/a><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This generation represents a real advance in targeting and patient comfort. I introduced Cambodia&#8217;s first 4th-generation lithotripter at Royal Phnom Penh Hospital in 2018, after training on the system at Chang Gung Memorial Hospital in Taiwan. At Bangkok Hospital Headquarters, ESWL is currently performed using a 3rd-generation lithotripter. The improvements of the 4th generation are these:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Automated stone localization:<\/strong> the system assists in finding and holding the target.<\/li>\n\n\n\n<li><strong>Radiation-free targeting:<\/strong> ultrasound rather than X-ray can be used to locate the stone, so a session can be completed without radiation exposure. In practice X-ray is still used in some cases, for example where the stone is not clearly seen on ultrasound.<\/li>\n\n\n\n<li><strong>Respiratory tracking:<\/strong> the ultrasound system follows the stone as it moves with the patient\u2019s breath, so more of the shockwaves land on the target rather than on surrounding tissue.<\/li>\n\n\n\n<li><strong>Less need for anesthesia:<\/strong> many patients tolerate treatment with little or no analgesia and return home the same day. This is about comfort during the session; it does not by itself mean more stones are cleared.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-video alignwide\"><video height=\"1080\" style=\"aspect-ratio: 1920 \/ 1080;\" width=\"1920\" controls src=\"https:\/\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/LITEMED-ESWL-4th-gen-clip.mp4\"><\/video><figcaption class=\"wp-element-caption\">A 4th-generation lithotripter (LITEMED) in operation \u2014 shown here to illustrate the technology described above. It is not the machine currently used at Bangkok Hospital Headquarters, where ESWL is performed with a 3rd-generation lithotripter.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What Determines Success?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Whichever generation of lithotripter is used, whether a stone breaks depends far more on the stone than on the machine:<\/p>\n\n\n\n<table style=\"width:100%; border-collapse: collapse; margin: 1.5rem 0; font-family: inherit;\">\n  <thead>\n    <tr style=\"background-color: #1a3a6b; color: #ffffff;\">\n      <th style=\"padding: 12px; text-align: left; border: 1px solid #1a3a6b;\">Factor<\/th>\n      <th style=\"padding: 12px; text-align: left; border: 1px solid #1a3a6b;\">Description<\/th>\n    <\/tr>\n  <\/thead>\n  <tbody>\n    <tr style=\"background-color: #f5f7fa;\">\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Stone hardness<\/strong><\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Not all stones are alike. CT scanning measures stone density in Hounsfield Units. Dense stones \u2014 calcium oxalate monohydrate and cystine in particular \u2014 resist shockwaves and may not fragment at all, whichever machine is used.<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Stone location<\/strong><\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Stones in the kidney or upper ureter generally do better than those in the lower pole, where fragments must travel uphill to leave the kidney and often simply stay there.<\/td>\n    <\/tr>\n    <tr style=\"background-color: #f5f7fa;\">\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Stone size<\/strong><\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">Stones under 10 mm do best. Above 10 mm, a single session clears fewer stones and a second treatment is more often needed.<\/td>\n    <\/tr>\n    <tr>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\"><strong>Body habitus<\/strong><\/td>\n      <td style=\"padding: 12px; border: 1px solid #d1d5db; vertical-align: top;\">The distance from skin to stone matters. Where that distance is large, the shockwave arrives with less energy and success falls \u2014 which is why ESWL is not the right choice for every patient.<\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">A note on the success figures quoted for ESWL, including on this site in the past. Published rates for stones under 10 mm are often given as roughly 85\u201390%, but those numbers move a great deal depending on what is being counted. Being stone-free on a CT scan is a far stricter test than having no fragment larger than 4 mm, and studies use both. Density, location and skin-to-stone distance shift the figure further. The honest way to use a published rate is as a starting point for a conversation about your own stone, not as a promise.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What ESWL Asks of You: Risks and Aftermath<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Non-invasive does not mean without consequence, and a history of the technology would be incomplete without saying what the treatment actually involves for a patient. Expected effects in the days afterwards include blood in the urine, bruising or tenderness of the skin over the treated side, and colicky pain as fragments make their way down the ureter \u2014 that pain can be worse than the original stone, and it is normal rather than a sign of failure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The complications worth knowing about are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Steinstrasse<\/strong> \u2014 literally a street of stones: fragments lining up and blocking the ureter. Increasing pain, or any pain accompanied by fever, after treatment needs assessment rather than waiting.<\/li>\n\n\n\n<li><strong>Infection<\/strong>, including sepsis from bacteria released as the stone breaks up. This is why a urine infection is treated before treatment, never during it.<\/li>\n\n\n\n<li><strong>Bleeding around the kidney<\/strong> (perirenal haematoma) \u2014 uncommon, and more likely with uncontrolled blood pressure or a bleeding tendency.<\/li>\n\n\n\n<li><strong>Incomplete fragmentation<\/strong>, needing a second session or a change of plan to ureteroscopy.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">ESWL is not suitable for everyone. It is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation that has not been managed beforehand, where there is an obstruction below the stone that would prevent fragments passing, and where an aortic or renal artery aneurysm sits in the shockwave path. Whether you can safely pause a blood thinner is a decision for the doctor who prescribed it, together with your urologist \u2014 never a decision to make on your own.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What happens after treatment is set out in detail in my <a href=\"https:\/\/drsoaraweeurology.com\/2023\/11\/21\/3rd-gen-eswl-patient-instruction\/\">patient instructions for 3rd-generation ESWL<\/a>, which is the machine used at Bangkok Hospital Headquarters. And because breaking a stone is not the same as solving the problem, the more important half of stone care is <a href=\"https:\/\/drsoaraweeurology.com\/2026\/05\/13\/kidney-stone-prevention-management-guide\/\">preventing the next one<\/a> \u2014 and for one stone type in particular, <a href=\"https:\/\/drsoaraweeurology.com\/2026\/06\/03\/uric-acid-kidney-stones-case-study\/\">medication can dissolve the stone rather than break it<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Final Thoughts<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The evolution of ESWL \u2014 from a wartime observation to a 4th-generation tracking system \u2014 is a testament to the power of medical innovation. My presentation in 2018 at Royal Phnom Penh Hospital was, in many ways, a celebration of this progress. But the lesson I took from it, and still hold, is that the machine is the least interesting variable. Whichever generation of lithotripter is used, ESWL remains a non-invasive, same-day treatment that allows most patients to return to normal life quickly \u2014 and careful patient selection matters far more than the age of the equipment. At Bangkok Hospital Headquarters, ESWL is performed using a 3rd-generation lithotripter, with candidates selected on the basis of stone size, location, density and body habitus. For stones that ESWL cannot handle well, flexible ureteroscopy with holmium laser (RIRS) is generally the better answer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are dealing with kidney stones and would like to discuss which treatment is right for you, Dr. Soarawee Weerasopone provides <a href=\"https:\/\/drsoaraweeurology.com\/services\/kidney-stone-treatment-bangkok\/\">specialist kidney stone care<\/a> at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at <a href=\"tel:0880221445\">Samitivej Sriracha Hospital, Chonburi \u2014 088-022-1445<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly \u2014 Bangkok Hospital at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>, or Samitivej Sriracha on <a href=\"tel:0880221445\">088-022-1445<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About ESWL<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What is ESWL and how does it break kidney stones?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ESWL (Extracorporeal Shockwave Lithotripsy) uses focused shockwaves generated outside the body to break kidney stones into small fragments. The shockwaves pass through the skin and tissue, concentrating their energy on the stone to fracture it into pieces small enough to be passed naturally in the urine.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What are the risks of ESWL, and when should I seek help after treatment?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Blood in the urine, skin tenderness over the treated side and colicky pain as fragments pass are expected in the days afterwards. The complications to know about are steinstrasse (fragments blocking the ureter), infection including sepsis, bleeding around the kidney, and incomplete fragmentation needing a further session. Seek care urgently for fever or shaking chills, pain that is escalating rather than settling, persistent vomiting, or passing little or no urine. In Thailand the emergency number is 1669.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Who should not have ESWL?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ESWL is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation not managed in advance, where an obstruction below the stone would stop fragments passing, and where an aortic or renal artery aneurysm lies in the shockwave path. Very dense stones and a large skin-to-stone distance also make ESWL a poor choice, and flexible ureteroscopy with holmium laser is often better in those situations. Never stop a blood thinner on your own \u2014 that decision belongs to the doctor who prescribed it.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is ESWL painful or does it require anesthesia?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">ESWL is generally well tolerated and is performed as a same-day procedure. How much pain relief is needed depends partly on the machine: with 4th-generation systems many patients need no anesthesia at all, while with 3rd-generation lithotripters \u2014 including the one used at Bangkok Hospital Headquarters \u2014 short-acting intravenous analgesia or light sedation is commonly given. In either case, patients normally return home the same day.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What size of kidney stone is best treated with ESWL?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Stones under 10 mm respond best. Published success rates for this group are often quoted around 85\u201390%, but the figure depends heavily on how success is defined \u2014 being completely stone-free on CT is a much stricter test than having no fragment above 4 mm \u2014 and on stone density, position and skin-to-stone distance. Stones above 10 mm may still respond but more often need a second session or a different approach.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Does modern ESWL still use X-ray radiation?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">It depends on the generation of the machine. Fourth-generation systems can localize the stone with ultrasound and complete a session without X-ray, although fluoroscopy is still used in some cases where the stone is not clearly visible. Third-generation lithotripters \u2014 including the one used at Bangkok Hospital Headquarters \u2014 rely on X-ray fluoroscopy for targeting, although exposure is brief and kept as low as reasonably achievable, and the dose is comparable to routine diagnostic imaging.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is a newer machine always better?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not in the way the word generation suggests. What improved most across the four generations was patient comfort, machine size and cost, and the accuracy of targeting. Stone clearance did not improve along the same straight line, and it depends far more on the density, size, position and depth of your particular stone. A well-selected patient on a 3rd-generation machine will do better than a poorly selected one on a 4th-generation machine.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/\",\n      \"name\": \"The Evolution of Stone Treatment: From War Zones to High-Tech Healing\",\n      \"headline\": \"The Evolution of Stone Treatment: From War Zones to High-Tech Healing\",\n      \"description\": \"A urologist traces extracorporeal shockwave lithotripsy from wartime observations of underwater blast injury to the first human treatment in 1980 and through four generations of lithotripter \u2014 with an honest account of what each generation did and did not improve, what determines whether a stone breaks, and the risks, contraindications and warning signs that follow treatment.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2026-05-06\",\n      \"dateModified\": \"2026-08-17\",\n      \"lastReviewed\": \"2026-08-17\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"disambiguatingDescription\": \"ESWL at Bangkok Hospital Headquarters is performed with a 3rd-generation lithotripter. The 4th-generation system described and shown in the video clip is not the machine in use there; it is the technology the author introduced at Royal Phnom Penh Hospital in Cambodia in 2018.\",\n      \"about\": {\n        \"@type\": \"MedicalCondition\",\n        \"name\": \"Kidney stones (urolithiasis)\",\n        \"signOrSymptom\": [\n          { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Flank pain or renal colic\" },\n          { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Blood in the urine\" },\n          { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Fever or rigors with flank pain \u2014 suggests an infected obstructed kidney and is a medical emergency requiring urgent drainage\" }\n        ],\n        \"possibleTreatment\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#eswl\" }\n      },\n      \"mainContentOfPage\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#eswl\" }\n    },\n    {\n      \"@type\": \"TherapeuticProcedure\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#eswl\",\n      \"name\": \"Extracorporeal Shockwave Lithotripsy (ESWL)\",\n      \"alternateName\": \"Shockwave lithotripsy\",\n      \"howPerformed\": \"Shockwaves generated outside the body are focused onto the stone, creating mechanical stress that fragments it into pieces small enough to pass in the urine. Targeting uses X-ray fluoroscopy on third-generation lithotripters and can use ultrasound with respiratory tracking on fourth-generation systems. Performed as a same-day procedure; short-acting intravenous analgesia or light sedation is commonly given with third-generation machines.\",\n      \"preparation\": \"A urinary tract infection must be treated before the procedure. Anticoagulation must be reviewed and managed in advance by the prescribing doctor together with the urologist. CT assessment of stone size, density in Hounsfield Units, position and skin-to-stone distance determines suitability.\",\n      \"followup\": \"Blood in the urine, tenderness over the treated side and colicky pain as fragments pass are expected. Escalating pain, pain with fever or rigors, persistent vomiting, or reduced urine output require urgent assessment.\",\n      \"contraindication\": {\n        \"@type\": \"MedicalContraindication\",\n        \"name\": \"Contraindications to ESWL\",\n        \"description\": \"Pregnancy; untreated urinary tract infection; uncorrected bleeding disorder or unmanaged anticoagulation; obstruction distal to the stone preventing fragment passage; aortic or renal artery aneurysm within the shockwave path. Very dense stones such as calcium oxalate monohydrate and cystine, and a large skin-to-stone distance, make ESWL a poor choice \u2014 flexible ureteroscopy with holmium laser is often preferable.\"\n      },\n      \"seriousAdverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Sepsis from bacteria released during stone fragmentation\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Steinstrasse \u2014 a column of fragments obstructing the ureter\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Perirenal haematoma\" }\n      ],\n      \"adverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Haematuria\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Colicky pain during fragment passage\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Incomplete fragmentation requiring a further session or a change to ureteroscopy\" }\n      ]\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2026\/05\/06\/evolution-of-stone-treatment-eswl\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What is ESWL and how does it break kidney stones?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"ESWL (Extracorporeal Shockwave Lithotripsy) uses focused shockwaves generated outside the body to break kidney stones into small fragments. The shockwaves pass through the skin and tissue, concentrating their energy on the stone to fracture it into pieces small enough to be passed naturally in the urine.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What are the risks of ESWL, and when should I seek help after treatment?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Blood in the urine, skin tenderness over the treated side and colicky pain as fragments pass are expected in the days afterwards. The complications to know about are steinstrasse (fragments blocking the ureter), infection including sepsis, bleeding around the kidney, and incomplete fragmentation needing a further session. Seek care urgently for fever or shaking chills, pain that is escalating rather than settling, persistent vomiting, or passing little or no urine. In Thailand the emergency number is 1669.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Who should not have ESWL?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"ESWL is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation not managed in advance, where an obstruction below the stone would stop fragments passing, and where an aortic or renal artery aneurysm lies in the shockwave path. Very dense stones and a large skin-to-stone distance also make ESWL a poor choice, and flexible ureteroscopy with holmium laser is often better in those situations. Never stop a blood thinner on your own; that decision belongs to the doctor who prescribed it.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is ESWL painful or does it require anesthesia?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"ESWL is generally well tolerated and is performed as a same-day procedure. How much pain relief is needed depends partly on the machine: with 4th-generation systems many patients need no anesthesia at all, while with 3rd-generation lithotripters, including the one used at Bangkok Hospital Headquarters, short-acting intravenous analgesia or light sedation is commonly given. In either case, patients normally return home the same day.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What size of kidney stone is best treated with ESWL?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Stones under 10 mm respond best. Published success rates for this group are often quoted around 85 to 90 percent, but the figure depends heavily on how success is defined, since being completely stone-free on CT is a much stricter test than having no fragment above 4 mm, and on stone density, position and skin-to-stone distance. Stones above 10 mm may still respond but more often need a second session or a different approach.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Does modern ESWL still use X-ray radiation?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"It depends on the generation of the machine. Fourth-generation systems can localize the stone with ultrasound and complete a session without X-ray, although fluoroscopy is still used in some cases where the stone is not clearly visible. Third-generation lithotripters, including the one used at Bangkok Hospital Headquarters, rely on X-ray fluoroscopy for targeting, although exposure is brief and kept as low as reasonably achievable, and the dose is comparable to routine diagnostic imaging.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is a newer machine always better?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Not in the way the word generation suggests. What improved most across the four generations was patient comfort, machine size and cost, and the accuracy of targeting. Stone clearance did not improve along the same straight line, and it depends far more on the density, size, position and depth of the particular stone. A well-selected patient on a third-generation machine will do better than a poorly selected one on a fourth-generation machine.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\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. No diagnosis, advice or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The technology that breaks kidney stones without a single incision began with an accidental wartime observation. Dr. Soarawee Weerasopone, urologist at Bangkok Hospital, traces the story of ESWL from that discovery to today&#8217;s lithotripters \u2014 and explains what each generation actually changed for patients.<\/p>","protected":false},"author":185281453,"featured_media":10239,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Dr. Soarawee, urologist at Bangkok Hospital, traces the evolution of Extracorporeal Shockwave Lithotripsy (ESWL) from WWII shockwave observations to today's fourth-generation kidney stone technology.","jetpack_seo_html_title":"The Evolution of ESWL: From WWII to 4th-Generation Lithotripsy | Dr. Soarawee","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-10181","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kidney-stone"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-2Ed","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/05\/The-Evolution-of-Stone-Treatment.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/10181","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/comments?post=10181"}],"version-history":[{"count":24,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/10181\/revisions"}],"predecessor-version":[{"id":11503,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/posts\/10181\/revisions\/11503"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/media\/10239"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/media?parent=10181"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/categories?post=10181"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/my\/wp-json\/wp\/v2\/tags?post=10181"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}