Extra Corporeal Shock Wave lithotripsy, popularly known as lithotripsy was launched in early 1980s with a big bang as a non-invasive panacea for urinary stone disease. After initial euphoria for a few years, it could not stand the test of time. Now–a-days, it is selectively recommended for small kidney stones, upper ureteric stones and residual stones after PCNL. Medical marketers publicize it as a painless modality when it is not entirely painless; a non-invasive modality when it is not truly non-invasive and highly effective when it is not so. ESWL, at the most, can break the stone; the problem is that it is not going to bring the stone out. Firstly, stone may not break and 2ndly, if the broken pieces are too big or too many, they are not going to come out. Hence, the procedure ends up in a failure. In well-selected cases, the efficacy is only about 70% even with the best machines and in expert hands. I have world’s best machine (Dornier Compact) which I use for scientifically selected cases only.