PURPOSE OF REVIEW: Since the first patient was successfully treated with extracorporeal shock wave lithotripsy in 1980, its rapid acceptance and widespread use have championed this form of stone therapy as the treatment of choice for the majority of renal and ureteral calculi. Worldwide clinical series have documented the efficacy and safety of shock wave lithotripsy. RECENT FINDINGS: Shock wave lithotripters have undergone modifications of the source for generation of shock waves, focusing, and even localization techniques since the introduction of the original Dornier HM3 lithotripter. Yet the basic concepts remain the same: to produce an acoustic wave that can be focused at a specific location for stone fragmentation. Safety and efficacy of the different generations of lithotripters is well documented. Indications and utilization of shock wave lithotripsy have expanded, with clinical efficacy approaching or exceeding that of other modalities of minimally invasive surgery. Complications, however, can arise as a result of shock wave therapy. SUMMARY: This review provides an update of the latest shock wave technology, reviewing the clinical indications and efficacy of treatment and discussing the potential adverse events associated with shock wave lithotripsy.