EWSL is usually recommended in the following cases:

1. When the stones are too large (more than 5 mm) to pass on their own, but less than 7 to 8 mm in size
2. Stones block the flow of the urine
3. Stones lead to infection or bleeding
4. Pain medicines are not effective when trying to pass stones

Contra-indications:
ESWL procedure is not recommended in the following cases:

• Kidney stones greater than 8mm in size
• History of ESWL procedure performed for the same stone more than once
• Pregnant women
• Presence of bleeding disorders
• Presence of cysteine stones and certain types of calcium stones
• Having urinary tract infections, kidney infections, or kidney cancer
• Having abnormal kidney function or structure
• If the kidney stone is in the pancreatic duct

1. Physical examination: The doctor will evaluate the physical health of the patient. The patient’s medical history and symptoms are noted.

2. Imaging tests: Tests like x-rays, abdominal ultrasounds, and MRI scans can help in obtaining a clear image of the internal organs and determining the exact location of the stone.

3. Blood urea nitrogen (BUN) test: This test helps in checking how well the kidneys are working.

4. Blood tests: They help in checking the levels of different blood parameters and if there is a presence of any underlying infections.

5. Urinalysis: Urine tests may be performed to check for the presence of any stones and check the composition of the stones if present.

1. The procedure may be performed under spinal anesthesia (the patient is numbed from the waist downwards) or general anesthesia (the patient is put to sleep before the procedure).
2. The patient is made to lie down on a water-filled tub or cushion. The water will act as a medium between the organs and the machine to prevent any damage to the surrounding tissues and organs.
3. Imaging tests like x-rays or abdominal ultrasounds are used to determine the precise location of the stone.
4. Once the exact location of the stone is determined, a series of high-energy sound waves are released by the surgeon to break the stone into smaller pieces.
5. The doctor will adjust the power and interval of sound waves to break the stone into smaller fragments.
6. The smaller fragments are then flushed out of the urinary tract.
7. The doctor may choose to insert a ureteral stent for a large stone. A stent enlarges the ureter passage, allowing smooth movements of the stones outside the body and reduceing the pain during the expulsion of the stone.
8. The procedure takes about 45 to 60 minutes to complete depending on the health of the patient, stone density, and expertise of the doctor.

The complications associated with an ESWL procedure are:

• Blocked flow of urine
• Bleeding around the kidneys
• Infection 
• Urinary tract infections
• May need multiple sittings to break the stones completely, which may lead to damage to the surrounding organs
• Incomplete or ineffective stone fragmentation
• Steinstrasse (accumulation of a number of unpassable stone fragments within the ureter)
• Diabetes
• Hypertension (high blood pressure)

• The procedure is usually performed on an outpatient basis, which means that you can go home on the same day of the procedure.
• It is normal to have some discomfort and pain over the flank or kidney area for a few days after the surgery.
• You can expect to pass stone pieces in your urine for many days or weeks after the surgery. These stone pieces may appear similar to dust, gravel, or sand.
• Some patients could experience some pain while passing the stone pieces. The doctor will recommend painkillers and certain dietary restrictions to relieve the discomfort till the stone fragments are flushed out of the body completely.
• The patient can usually resume work within two to three days after the procedure.
• You can perform mild physical activities that do not strain the lower body during the recovery period.

Home remedies:

• Drink a minimum of eight glasses of water a day. It will help the stone fragments to pass and also decrease the amount of blood in the urine.
• Strain your urine and send the stone fragments to the urologist for evaluation.
• Take pain-relieving medications as directed by your doctor.
• Follow all the dietary restrictions provided by your doctor.

Cost of ESWL Surgery in India- 

The cost of ESWL surgery in Mumbai is between INR 20,000 to INR 90,000.
The cost of ESWL surgery in Delhi is between INR 18,000 to INR 85,000.
The cost of ESWL surgery in Bangalore is between INR 18,000 to INR 85,000.
The cost of ESWL surgery in Chennai is between INR 15,000 to INR 80,000.