Observation with follow-up
Selected ureteral stones may be monitored when symptoms are controlled, infection is absent and kidney function is acceptable. Observation needs a defined follow-up and reassessment plan.
Home / Office ESWL
Kidney stone treatment: ESWL, ureteroscopy or PCNL?
Explore the illustrated guide ↓
Compare observation, office shockwave lithotripsy and other stone procedures. Your imaging and health guide the treatment and facility that fit your situation.
See it illustrated
Explore selected illustrations, then open a guide to see the full image and related reading.
When a Kidney Stone Can Wait—and When It Cannot
Open illustrated guide →
The Kidney Protection Map
Open illustrated guide →Ureteroscopy vs PCNL: how are they different?
Ureteroscopy reaches the stone through the natural urinary passage. Percutaneous nephrolithotomy (PCNL) uses a small access tract through the back into the kidney, often for larger or more complex stones. ESWL breaks suitable stones using shockwaves from outside the body.
The choice depends on stone size, location, anatomy, infection, medicines and earlier treatment. Ask about the chance of needing another procedure, a temporary stent and the expected recovery. NY Litho evaluates suitable patients for office ESWL and discusses the appropriate treatment setting when another approach is needed.
Printable kidney-stone treatment guide · Understand your stone and imaging.
Plan your kidney stone evaluation
Bring your scan images and reports, discharge papers and medication list. Our team will confirm your appointment, office and preparation instructions.
Compare stone treatment options · Check ESWL suitability · Prepare for your treatment visit · Plan stone prevention
Compare the approaches before choosing a procedure
Shockwave lithotripsy (ESWL)
Shockwaves break a suitable stone from outside the body. Fragments still need to clear, and follow-up establishes progress; another treatment may be needed.
Ureteroscopy
A small scope passes through the urinary tract to treat a stone, sometimes using a laser and extraction tools. A temporary ureteral stent may be part of the plan.
Percutaneous stone treatment
Selected larger or more complex kidney stones may need treatment through an access tract into the kidney. The stone burden, anatomy and health risks guide this discussion.
NY Litho provides evaluation and appropriate office ESWL. When another approach is more suitable, we discuss the next step and appropriate treatment facility.
Office ESWL: before, during and after treatment
An external, incision-free approach for suitable stones, with specialist evaluation, an individual anesthesia plan and follow-up.
Before treatment
We review your imaging, medications and health to decide whether ESWL is appropriate.
During treatment
Focused shockwaves reach the stone from outside your body. Our office protocol allows clothes-on treatment; preparation and anesthesia are individualized.
Stents
A stent is not routinely needed for ESWL. Some patients still need drainage or a stent for safety.
After treatment
Fragments pass afterward. Follow-up checks progress; another session may be needed.
Come in for a kidney stone evaluation
Bring your imaging and hospital records. We review your stone’s size, location and density, your symptoms and your health, then recommend a plan. ESWL suitability and timing are individual.
(212) 991-9991When to seek urgent care
Fever or chills with stone symptoms, inability to urinate, persistent vomiting or uncontrolled pain require urgent medical assessment. An infected blockage is an emergency; do not wait for an office ESWL appointment.
A simpler treatment day, when ESWL is right for you.
No incision. No scope inside the urinary tract.
Focused shockwaves reach the stone from outside your body. Fragments then pass in the urine.
Stay in your own clothes.
For our office ESWL protocol, you can remain in your own clothes; the team adjusts clothing at the treatment area as needed for skin contact and imaging. Preparation depends on your care plan.
A stent is rarely needed in our selected ESWL patients.
Dr. Shusterman describes stents as uncommon in his selected office ESWL patients. This is practice experience, not a measured percentage or a promise. A stent may still be needed for blockage, infection or difficulty passing fragments.
Fast visit. Individual preparation.
Your appointment includes imaging review, treatment and recovery. If your plan uses sedation, follow fasting instructions, arrange an escort and do not drive afterward. The team confirms timing before your visit.
What NYLitho offers after a hospital visit
Use these questions when comparing follow-up options. Services at other practices vary; ask them directly.
| What to ask | NYLitho care |
|---|---|
| How soon can I be evaluated? | Urgent appointment requests are triaged; our team confirms the earliest appropriate opening. |
| Can you check whether the stone passed? | Office ultrasound, review of prior imaging and CT when indicated, with a follow-up plan. |
| Can I try to pass it safely? | Observation and medication when suitable, including Flomax for selected ureteral stones; review passage and kidney safety. |
| What if pain returns? | Reassessment and IV Toradol for suitable patients; emergency hospital care when warning signs require it. |
| Can treatment be done in the office? | Dornier ESWL with in-office anesthesia for suitable stones; expedited scheduling after assessment and preparation. |
| Will I need a stent or surgery? | A stent is not routinely needed for ESWL. Some patients still need drainage or a stent for safety. |
What if pain returns?
Will I need a stent or surgery?Fever or chills, inability to urinate, uncontrolled pain or repeated vomiting need immediate emergency assessment. Do not wait for an office appointment.
Request urgent stone careUNDERSTAND YOUR CARE
Protect the kidney as well as treating the stone
A stone episode raises two related questions: what needs to happen now, and what will protect kidney function and reduce future risk? Pain relief is important, but it does not by itself prove that drainage is normal.
The safety assessment extends beyond stone size
Infection, obstruction, kidney reserve, symptom control, pregnancy and the ability to return for follow-up can change the plan. A small stone can be dangerous in an infected obstructed system; a larger nonobstructing finding may lead to a different discussion. Imaging and selected urine or blood tests put the symptoms in context.
Urgent drainage with a stent or nephrostomy and definitive stone removal are different tasks. When infection makes the situation unstable, protecting drainage and treating infection may come first. If observation is appropriate, the plan should say how passage or relief of obstruction will be confirmed, not rely only on whether pain disappears.
Use the episode to plan ongoing kidney protection
Bring stone-analysis results, prior scans, kidney-function tests and a list of medications and supplements. The number of working kidneys, earlier procedures, infections, bowel disease and other health conditions may affect prevention and surveillance. Keep actual reports so that changes over time can be compared.
The prevention plan may use stone composition and a properly collected 24-hour urine study to identify a target. That complements the detailed stone-treatment and prevention guidance already on this page. Ask what will be measured again, how medication or diet changes will be monitored, and whether other clinicians need to help manage kidney or metabolic risks. The goal is a repeatable plan that fits work, heat, exercise and travel, rather than a one-time instruction to drink more water or avoid a long list of foods.
Questions to bring to your visit
- Is my kidney draining safely, and how will we confirm it?
- Does my kidney reserve change the threshold for treatment?
- Which results should we remeasure to assess prevention and kidney protection?
When to seek care: Fever with a suspected obstructing stone is an emergency. Seek urgent care for inability to urinate, uncontrolled pain, persistent vomiting or worsening illness, especially with one functioning kidney.
Explanation adapted from A Urology Consult in a Book by David Shusterman, MD, chapter 31, “Protecting Kidney Function.” Original illustration reproduced from the book. EAU: stone management.