Urology - Kidney Stone Centre

Treatment options

Shockwave Lithotripsy: Contraindications to Shockwave Lithotripsy

To make sure that shockwave lithotripsy (SWL) is absolutely safe, patients with the following conditions should not undergo SWL. If you have any of the following, please notify your doctor prior to going for SWL:

  • Untreated urinary tract infection (UTI).  UTI’s must be either treated or eliminated with an antibiotic before SWL can be safely performed.
  • Pregnancy is a case in which SWL is unsafe, and women who are pregnant or who might be pregnant should notify their urologist so that a different treatment plan can be developed.
  • Severe high blood pressure can cause bleeding with SWL, and so blood pressure must be controlled with appropriate medication before treatment can occur.
  • Blood thinners and aspirin-like drugs must be stopped before SWL can be performed, in order to minimize the risk of bleeding. Review all medications (over-the-counter, herbal, prescription, including topical, oral, inhalers) with your doctor or pharmacist to determine if any have a blood thinning effect.

- If you are taking any medications that have a blood thinning effect, please check with your doctor if it is safe to stop before treatment and when to stop taking them. Do NOT stop taking them without first speaking to your doctor.

Examples of blood thinners are: warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradax), apixaban (Eliquis), heparin, low-molecular weight heparin

-  If you are taking any antiplatelet medications or medications containing ASA or a non-steroidal anti-inflammatory (NSAID), please check with your doctor if it is safe to stop 7 days before treatment. An exception is ticlodipine (Ticlid) which requires 10 days.

Examples of antiplatelet medications are: ASA (acetylsalicylic acid or Aspirin), clopidogrel (Plavix), ticlodipine (Ticlid), Aggrenox, prasugrel (Effient)

Examples of non-steroidal anti-inflammatories (NSAID) are: ibuprofen (Advil, Motrin), Indomethacin, naproxen (Aleve), naproxen sodium (Anaprox), Percodan, ketorolac (Toradol) or diclofenac (Voltaren, Arthrotec, Voltaren gel, Pennsaid).

If your doctor says that it is not safe for you to stop your blood thinners, antiplatelet drugs or NSAIDS as described above, then please call the Kidney Stone Centre (at 416 864-3030) and your urologist.

Shockwave Lithotripsy cannot be done if you have not stopped your blood thinners, antiplatelets or NSAIDS as instructed by your doctor before your treatment date.

  • Fasting before SWL treatment. Since shockwave lithotripsy is performed under intravenous sedation, it is important for you to have an empty stomach when you come for treatment.

- On the day of your procedure, you are not allowed to eat solid food, chewing gum or candy.

- You may drink one glass (250 mL) of a clear liquid up until three hours before your check-in time. Examples of clear fluids:  water, real or artificial fruit juices with no pulp, clear tea and black coffee with no milk or cream. No carbonated or alcoholic beverages.

- If your medication does not interfere with the treatment after checking with your doctor, you can take it as usual on the day of your treatment with a small sip of water.