More than 10 years after its clinical introduction, extracorporeal shock-wave lithotripsy (ESWL) has proved to be the safest treatment modality for most urinary calculi. After careful preparation, even patients with severe coagulation disorders can be treated by ESWL. Shock-wave lithotripsy for small symptomatic renal stones resulted in a disintegration rate of 84%, a stone-free rate of 50% and a complaint-free rate of 52%. A 50% chance of success may justify ESWL treatment as initial approach for stones in caliceal diverticula. A 70% stone-free rate was reported for stone-bearing horseshoe kidneys, but the recurrence rate was 29%. In the case of nephrocalcinosis in medullary sponge kidneys, the pain-free application of shock waves is a major advantage because multiple sessions are necessary together with medical treatment. The use of indwelling stents has contributed to the extension of indication for ESWL monotherapy, even for staghorn calculi, because acute morbidity is reduced. Double-J stents, however, do not improve the stone-free rate and special attention should be paid to stent morbidity. Depending on stone localization, post-ESWL long-term stone-free rates are 58–84% with a recurrence rate of 6–20% after 2–4 years. The main features of third generation lithotriptors are a combined localization system allowing interdisciplinary lithotripsy and integration of the shock-wave source in an endoscopic treatment table for multifunctional use.