Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive technique that utilizes focused shock waves to fragment stones into sand-sized particles, which then pass spontaneously with urination. The clinical use of this technique was introduced in 1980 in Germany by Chaussy and associates and has replaced most open surgery and percutaneous endoscopy for stone removal. The physics of shock waves, equipment, techniques, and patient selection in ESWL are discussed. Results of treatment of renal, upper ureteral, and lower ureteral calculi are reviewed and compared. Complications of treatment, including ureteral obstruction, hemorrhage, and tissue damage, are discussed. The advent of second-generation lithotripters has widened the parameters for patient selection in the treatment of ESWL and has increased the availability of this treatment modality.