{"id":3217,"date":"2021-06-18T08:00:00","date_gmt":"2021-06-18T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=3217"},"modified":"2026-08-15T00:21:22","modified_gmt":"2026-08-14T17:21:22","slug":"4th-generation-%e1%80%98%e1%80%9a%e1%80%ba%e1%80%9c%e1%80%ad%e1%80%af%e1%80%a1%e1%80%9c%e1%80%af%e1%80%95%e1%80%ba%e1%80%9c%e1%80%af%e1%80%95%e1%80%ba%e1%80%9c%e1%80%b2%e1%81%8b","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2021\/06\/18\/eswl-how-the-4th-generation-works\/","title":{"rendered":"4th Generation ESWL \u1000 \u1018\u101a\u103a\u101c\u102d\u102f\u1021\u101c\u102f\u1015\u103a\u101c\u102f\u1015\u103a\u101c\u1032\u104b"},"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\/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=\"Best Urologist working in Chonburi and Cambodia\" 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, 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Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\" target=\"_blank\" rel=\"noreferrer noopener\">Samitivej Sriracha Hospital \u2014 Urology department: <strong>088-022-1445<\/strong><\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-background-background-color has-text-color has-background has-link-color has-small-font-size has-custom-font-size wp-element-button\" href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" style=\"color:#1b4965\" target=\"_blank\" rel=\"noreferrer noopener\">Book a 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.242.005.448.013.618.008.17.02.314.034.43.013.117.03.21.05.282.02.072.042.137.066.197.105.216.28.39.527.518.246.13.57.193.972.193.4 0 .714-.07.94-.21.227-.14.394-.346.503-.617a2.43 2.43 0 0 0 .104-.395c.018-.123.027-.282.027-.477V13.2H2.34c-.04 0-.06-.02-.06-.062v-.5c0-.04.02-.062.06-.062h1.812c.04 0 .062.02.062.06v.5c0 .156-.005.296-.014.422a4.71 4.71 0 0 1-.04.342 1.732 1.732 0 0 1-.064.262c-.13.523-.402.913-.815 1.17-.413.255-.95.382-1.61.382z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/orcid.org\/0009-0004-8387-3559\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"ORCID iD\"\n     aria-label=\"View ORCID Profile\"\n     style=\"text-decoration: none; color: #A6CE39; 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=\"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\">Extracorporeal Shockwave Lithotripsy (ESWL) is a minimally invasive treatment for kidney stones. This article explains what the 4th generation of lithotripter technology added over earlier machines. It is written as general education about the technology itself \u2014 it does not describe the equipment at any one hospital. 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\/eswl-soarawee-thai-urologist\/\">history of all 4 ESWL generations<\/a>, see the linked articles.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A note on our own equipment:<\/strong> ESWL at Bangkok Hospital Headquarters is currently performed with a <strong>third-generation lithotripter<\/strong>, as a daycare procedure with short-acting intravenous analgesia or light sedation for comfort. I introduced 4th-generation ESWL to Cambodia at Royal Phnom Penh Hospital in 2018, after training at Chang Gung Memorial Hospital in Taiwan \u2014 but that machine is not the one in use at BHQ today.<\/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=my-MM&#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 following shockwave lithotripsy for a kidney stone.<\/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 aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"3237\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/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=\"A 4th-generation extracorporeal shockwave lithotripsy machine, shown for illustration\" 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\">A 4th-generation lithotripter, shown for illustration. Bangkok Hospital Headquarters performs ESWL with a 3rd-generation machine.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">What 4th Generation ESWL added over previous generations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Auto-tracking system<\/strong> \u2014 4th-generation machines use an automated targeting system that continuously tracks and locks onto the stone. This helps shockwaves hit the stone accurately and reduces unnecessary energy delivery to surrounding kidney tissue<\/li>\n\n\n<li><strong>Less need for sedation<\/strong> \u2014 because less energy reaches tissue around the stone, the procedure is generally better tolerated, and many centres perform it as a daycare treatment with minimal or no sedation<\/li>\n\n\n<li><strong>Higher reported targeting accuracy<\/strong> \u2014 manufacturer and comparative reports describe a hit rate of around 98.5% for 4th-generation systems, against roughly 82.6% for 3rd-generation machines<\/li>\n\n\n<li><strong>Fewer complications<\/strong> \u2014 greater targeting precision means less trauma to surrounding renal tissue<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">None of this means older machines do not work. A 3rd-generation lithotripter remains an effective, well-established treatment for appropriately selected stones; the practical difference is that patients are given short-acting intravenous analgesia or light sedation for comfort during the session.<\/p>\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=\"3238\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/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=\"Diagram of the auto-tracking targeting system used in 4th-generation ESWL\" 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 advance of 4th Generation ESWL.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">ESWL success rates by stone size<\/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. Reported outcomes fall broadly in these ranges:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Stone &lt; 1 cm:<\/strong> around 84% success<\/li>\n\n\n<li><strong>Stone 1\u20132 cm:<\/strong> around 77% success<\/li>\n\n\n<li><strong>Stone &gt; 2 cm:<\/strong> around 60% success<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Stone size is only one factor. Stone density on CT, its position within the kidney, the patient&#8217;s body habitus, and the distance from skin to stone all influence how well any lithotripter performs.<\/p>\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=my-MM&#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<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 different from previous generations?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The defining feature of 4th-generation ESWL is its auto-tracking system, which continuously locks onto the kidney stone as it moves with breathing. Reported targeting accuracy is around 98.5%, compared with roughly 82.6% for 3rd-generation machines. Better targeting means less energy reaches the tissue around the stone, which reduces discomfort during the session and allows many centres to treat with minimal or no sedation. Earlier-generation machines remain effective; they simply rely more on operator adjustment and on giving the patient analgesia or light sedation for comfort.<\/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. Reported success rates are approximately 84% for stones under 1 cm, 77% for 1\u20132 cm stones, and 60% for stones over 2 cm, where success is defined as residual fragments under 4 mm at follow-up. Stones larger than 2 cm may require additional sessions or an alternative procedure. Guidelines list percutaneous nephrolithotomy (PCNL) as first-line above 2 cm, but PCNL requires a tract created through the flank into the kidney; Dr. Soarawee&#8217;s preference is to attempt <a href=\"https:\/\/drsoaraweeurology.com\/2020\/06\/26\/holmium-laser-kidney-stone\/\">retrograde intrarenal surgery (RIRS) with the holmium laser<\/a> wherever it is feasible, since it reaches the stone through the natural urinary passage with no incision and modern flexible ureteroscopy handles stones of almost any size. Stone density, position and body habitus also affect the result.<\/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\">This depends on the generation of machine. General anesthesia is not required for ESWL in either case. With a 4th-generation system, the auto-tracking function limits shockwave energy reaching tissue around the stone, so many centres treat with minimal or no sedation. With a 3rd-generation lithotripter \u2014 which is what is used at Bangkok Hospital Headquarters \u2014 patients are given short-acting intravenous analgesia or light sedation so the session is comfortable. Either way ESWL is a daycare procedure: patients go home the same day, with no post-anesthetic recovery stay.<\/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>. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on <a href=\"tel:0880221445\">088-022-1445<\/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. No medical advice, diagnosis or prescription is provided through personal messaging channels. 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 different from previous generations?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Auto-tracking continuously locks onto the stone. Reported targeting accuracy is about 98.5% versus roughly 82.6% for 3rd-generation machines. Better targeting means less energy reaches surrounding tissue, so many centres treat with minimal or no sedation. Earlier-generation machines remain effective and rely more on operator adjustment plus analgesia or light sedation.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"What size kidney stones can ESWL treat?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"EAU guidelines recommend ESWL for stones under 2 cm. Reported success: about 84% under 1 cm, 77% for 1-2 cm, 60% over 2 cm, defined as residual fragments under 4 mm at follow-up. Stones above 2 cm may need repeat sessions or another procedure. Guidelines list PCNL as first-line above 2 cm, but it requires a tract through the flank into the kidney; Dr. Soarawee prefers to attempt retrograde intrarenal surgery (RIRS) with the holmium laser wherever feasible, since it reaches the stone through the natural urinary passage with no incision. Stone density, position and body habitus also affect results.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Is ESWL painful, and is anesthesia required?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"General anesthesia is not required. With a 4th-generation system many centres treat with minimal or no sedation. With a 3rd-generation lithotripter, which is what Bangkok Hospital Headquarters uses, patients receive short-acting intravenous analgesia or light sedation for comfort. Either way ESWL is a daycare procedure and patients go home the same day.\"\n      }\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Not all shockwave lithotripters are the same. Dr. Soarawee Weerasopone, urologist at Bangkok Hospital, explains what 4th-generation ESWL machines added over earlier ones, what the success rates by stone size really are \u2014 and which generation is used at Bangkok Hospital Headquarters today.<\/p>","protected":false},"author":185281453,"featured_media":10009,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"How 4th-generation ESWL works: auto-tracking, targeting accuracy, and success rates by stone size \u2014 plus what generation of lithotripter is used at Bangkok Hospital Headquarters. 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