The Stone Wars: Why ESWL Isn’t Going Away
Ureteroscopy overtook ESWL years ago. The procedure data show why that was not the end of the story.
2,433 Facilities
Identified with ESWL activity in commercial claims data.
2,984 Facilities
Identified with ureteroscopy activity over the same period.
1,969 In Both
Facilities appearing in both procedure datasets.
In 2013, Medicare physicians performed more extracorporeal shock wave lithotripsy (ESWL) procedures than ureteroscopies. By 2016, the order had reversed.
A national Medicare analysis found a significant rise in ureteroscopy from 2013 through 2020, while ESWL utilization remained comparatively stable. A 2025 systematic review reached a similarly clear conclusion: flexible ureteroscopy generally produced higher stone-free rates and fewer retreatments, while ESWL remained less invasive and continued to have a role for selected patients.1,2
The 2026 AUA and EAU guidelines reinforce the nuance. Procedure choice still depends on the stone, the patient, anatomy, available resources and physician expertise—not on a single universal winner.3,4
Ureteroscopy won the volume race. It did not eliminate the ESWL market.
What the Procedure Data Show
ClearSight Health analyzed U.S. facility activity for ESWL and two ureteroscopy procedure groups—ureteroscopy with laser lithotripsy and ureteroscopy with stone removal—using commercial claims data refreshed through Q2 2026.
More than four in five facilities identified with ESWL activity also appeared in the ureteroscopy dataset. The highest-volume locations were not divided neatly into “old” and “new” treatment centers. Many were active in both.
Facilities Leading Kidney Stone Procedures
| Facility | City, State |
|---|---|
| Summit Medical Group Pa | Berkeley Heights, New Jersey |
| The Stone Center of New Jersey, Llc | Short Hills, New Jersey |
| The Urology Center Llc | Cincinnati, Ohio |
| Mississippi Baptist Medical Center, Inc. | Byram, Mississippi |
| Keystone Kidney Associates, Pc | Warminster, Pennsylvania |
| Baptist Health Louisville | Louisville, Kentucky |
| Usmd Hospital at Arlington, L.p. | Arlington, Texas |
| Corewell Health Grand Rapids Hospital | Grand Rapids, Michigan |
| Lowcountry Ambulatory Center, Llc | Charleston, South Carolina |
| Center For Urologic Surgery Llc | Saint Louis, Missouri |
Ranked by combined observed activity across the selected ESWL and ureteroscopy procedure groups. Facility names link to ClearSight profiles.
Physicians Performing High Volumes of ESWL
| Physician | City, State |
|---|---|
| Glen Diacon | Ada, Oklahoma |
| Stephan Sweitzer | Louisville, Kentucky |
| Raymond Russell | Miamisburg, Ohio |
| Michael Hsia | Florence, South Carolina |
| Benjamin Gibson | Cambridge, Ohio |
| Mark Byron | Jesup, Georgia |
| Bradford Black | Canton, Ohio |
| James Okelly | Florence, South Carolina |
| Marc Janis | Yonkers, New York |
| Hamayun Mian | Green Bay, Wisconsin |
Based on the uploaded ESWL physician report. Physician names link to ClearSight profiles.
A Market That Specialized—Not Disappeared
The national shift toward ureteroscopy is real. So is the continued presence of ESWL.
The facility overlap suggests that the market did not simply divide into ureteroscopy centers and ESWL holdouts. Instead, many high-activity stone programs continue to support both approaches, while a smaller group of physicians and facilities maintains substantial ESWL activity.
Ureteroscopy changed the center of gravity in kidney stone treatment. ESWL remained part of the landscape.
References
- Kaplan-Marans E, et al. National Utilization, Reimbursement, and Urban Versus Rural Trends of Extracorporeal Shockwave Lithotripsy and Ureteroscopic Laser Lithotripsy. Urology. 2023;174:48–51. View source
- Nedbal C, et al. Cost and Effectiveness of Flexible Ureteroscopy Versus Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-analysis. European Urology Focus. 2025. View source
- Pearle MS, et al. Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026), Part II. Journal of Urology. 2026. View source
- European Association of Urology. EAU Guidelines on Urolithiasis. 2026. View source
- ClearSight Health. Analysis of U.S. facility activity for ESWL, ureteroscopy with laser lithotripsy and ureteroscopy with stone removal, and physician activity for ESWL. Commercial claims data refreshed through Q2 2026.
