Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment for selected kidney and ureteral stones that uses focused shock waves generated outside the body to break the stone into smaller fragments that can then pass naturally through the urinary tract. It does not require an incision or placement of a camera into the urinary tract (therefore the least invasive stone treatment option) and is generally most effective for appropriately sized and positioned stones. Being the least invasive, it has lower stone clearance rates, though only 11% of patients go on to need another stone procedure for complete stone clearance after ESWL.

ESWL is typically performed as an outpatient procedure, with most patients returning home the same day. Several treatment sessions may occasionally be necessary, and a temporary ureteral stent may be placed before or after treatment in selected patients. Blood in the urine, bruising, flank discomfort, and passage of stone fragments are common during the recovery period. Risks include infection, bleeding, incomplete stone fragmentation or clearance, blockage from stone fragments ("steinstrasse"), injury to surrounding tissue, and the need for additional stone treatment.