Start with your stone, not a generic treatment chart
Bring the imaging that identified the stone, your hospital record and a current medication list. We review size, position, density, drainage and symptoms, then discuss whether office ESWL fits your circumstances. Having a stone does not automatically mean that it needs immediate treatment. The purpose of the visit is to establish a clear, individual plan.
Prepare for the treatment conversation
Tell us about blood thinners, bleeding conditions, pregnancy possibility, infections, allergies and prior anesthesia experiences. Do not stop prescribed medication yourself. Ask which preparation instructions apply to you, how anesthesia will be arranged and whether you will need a driver. Our office protocol allows clothes-on treatment; the specific preparation and anesthesia instructions still matter.
Plan for what happens after shockwaves
ESWL breaks a suitable stone into smaller pieces that must pass afterward. A stent is not routinely needed for ESWL, but individual safety needs can change that plan. We explain possible symptoms, whom to contact and how progress will be checked. A second treatment session may be needed; the follow-up visit closes the loop between treatment and actual clearance.
The treatment decision, from scan to follow-up
Adapted from Stones Unlocked by David Shusterman, MD.
What the scan can and cannot predict
A CT report may describe diameter, position and density in Hounsfield units. Density is a useful clue about how a stone may respond to shockwaves, but it is not the same as laboratory identification of composition. The route fragments must travel, lower-pole anatomy, skin-to-stone distance and total stone burden can also affect clearance. Review the actual images with the clinician. An apparently small stone in an unfavorable position may need a different discussion from an equally sized stone elsewhere. Ask what makes your stone a good or poor candidate rather than treating one measurement as a guarantee.
Ask about alternatives and the stent plan
The comparison includes observation when safe, ESWL, ureteroscopy and, for selected larger burdens, percutaneous treatment. Ask about the chance of fragments remaining, repeat sessions and access to another procedure if the first approach is insufficient. A temporary ureteral stent supports drainage when needed; it may cause urgency, discomfort or blood in the urine. Avoid making “no stent” the sole measure of a good plan. If a stent is placed, get its purpose, removal date or scheduling route, and instructions for symptoms that need attention. Confirm the exact procedure and facility rather than assuming every treatment is available in the office.
Leave with a first-week recovery plan
Before treatment, confirm fasting instructions, your medication plan, anesthesia, transportation and a reachable contact for problems. Do not stop a blood thinner on your own. After treatment, know how to use prescribed medicines, whether to strain urine and when work or exercise can resume. Fever, shaking chills, worsening or uncontrolled pain, inability to urinate, heavy bleeding or clots, persistent vomiting or feeling seriously unwell needs prompt assessment. Some bleeding or discomfort can occur after a procedure, but that does not make every new symptom harmless. Follow the individualized discharge instructions and keep the planned follow-up.
Explore the visual stone guide · Reader companion and printable tools
Your next steps
- Send or bring existing imaging and records.
- Confirm preparation and transportation instructions with the office.
- Leave with a follow-up plan and contact instructions.
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Adapted from Stones Unlocked by David Shusterman, MD. Treatment and prevention are individualized.