St Vincent's Private
Suite 1303, Level 13, St Vincent's Private Hospital
406 Victoria Street, Darlinghurst NSW 2010
Sydney Lithotripsy Clinic
Focused information on lithotripsy for urinary stones
Lithotripsy means breaking stones into smaller pieces. That can be done with shockwaves from outside the body (ESWL), with a holmium laser through a telescope (ureteroscopy), with ultrasonic or pneumatic probes during keyhole kidney surgery (PCNL), or with mechanical crushing of bladder stones (endoscopic litholapaxy). The right method depends on where the stone sits, how large and dense it is, and your general health.
4Main modalities explained here
3Consulting locations
20+ yrsLaser ureteroscopy experience
Severe pain with fever needs urgent care. Stone pain together with fever, rigors, or feeling very unwell can mean an infected blocked kidney. That is a medical emergency: call 000 or go to an emergency department. After stabilisation, the stone is treated once the infection is controlled.
Modalities
Four ways stones are fragmented
These pages expand the stone treatment material published on the Urology NSW kidney stone hub, with lithotripsy as the organising topic rather than a short subsection.
ESWL (shockwave)
Focused acoustic shockwaves from outside the body. Often used for favourable smaller kidney stones and selected ureteric stones.
Read about ESWLHolmium laser
Intracorporeal lithotripsy through a ureteroscope. Workhorse for many ureteric stones and kidney stones up to about 2 cm.
Read about laser URS / RIRSUltrasonic and pneumatic
Probes used through a PCNL tract to break and aspirate large or staghorn stone volumes, often together with laser.
Read about PCNL toolsEndoscopic litholapaxy
Mechanical crushing of bladder stones via a cystoscope when a stone is too large to remove in one piece.
Read about litholapaxyFrom imaging to follow-up
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Confirm the diagnosis
Non-contrast CT of the kidneys, ureters, and bladder (CT KUB) is the usual standard to see stone size, density on Hounsfield units, and whether the kidney is blocked.
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Match treatment to the stone
Guidelines such as the AUA kidney stone statements (2026) and the EAU urolithiasis guideline (2025) frame which options are first-line for which stone sizes and positions. Your urologist applies that framework to your scan and your preferences.
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Recover, then prevent recurrence
After treatment, many patients benefit from hydration advice, diet changes, and sometimes metabolic testing if stones recur.
About the urologist
Dr Raji Kooner
Dr Kooner is a urological surgeon with a long-standing interest in stone disease. He has performed ureteroscopy and pyeloscopy with holmium laser lithotripsy for more than 20 years using a high-powered Coherent holmium platform with Moses technology, and works within a practice that offers the full range of contemporary stone treatments discussed on the Urology NSW kidney stone page.
Clinical care is coordinated through Urology NSW. This satellite site groups lithotripsy-specific information in one place.
Common questions
Is lithotripsy always shockwaves?
In everyday language many people say lithotripsy when they mean ESWL. In urology, lithotripsy also includes laser fragmentation inside the ureter or kidney, ultrasonic and pneumatic probes used at PCNL, and mechanical litholapaxy for bladder stones.
Can I have ESWL if I take blood thinners?
ESWL is generally avoided while on anticoagulant or antiplatelet drugs because of bleeding risk around the kidney. Flexible ureteroscopy with holmium laser is often used when stone treatment is needed and tablets cannot safely be stopped, because it avoids shockwave tissue effects and avoids the renal puncture used in PCNL. Any plan is made with your cardiologist or haematologist.
Will one treatment always clear the stone?
Not always. ESWL sometimes needs repeat sessions, and a minority of stones resist shockwaves altogether. Laser ureteroscopy aims to clear fragments at the time of surgery where anatomy allows. PCNL is designed for large volumes in one admission but can rarely need a second look.
Consulting locations
Mater Hospital North Sydney
Suite 1.12, Level 1
3–9 Gillies Street, North Sydney NSW 2060
Bowral
Suite 9, 70 Bowral Street
Bowral NSW 2576