Renal lithiasis, a common malady from which many individuals suffer, can result in significant morbidity and mortality. Few therapeutic options have been available until recently. Extracorporeal shock-wave lithotripsy (ESWL) is a new non-invasive modality for destruction of kidney stones. Shorter hospital stay, radically reduced recovery period and lack of harmful sequelae have rapidly elevated ESWL to the procedure of choice for most renal calculi. Description of ESWL development, the actual procedure and the role of the nurse practitioner are discussed.