Currently, most symptomatic nonpassable upper urinary tract calculi in the United States are managed with extracorporeal shock wave lithotripsy (ESWL), making this remarkable, noninvasive technique one of the most commonly performed procedures by urologists in the United States. There are currently more than 400 lithotriptors in the United States, and with the adaptation of lithotripters to mobile systems, ESWL now is distributed widely in America, with virtually every hospital having access to ESWL services if it so desires. The widespread acceptance of ESWL by patients, providers, and payers is a testament to the advantages of lithotripsy over more invasive treatment options for urolithiasis. In this article, the author briefly reviews the early development of the lithotriptor, provides a detailed review of lithotriptors currently available, and gives an overview of present ESWL indications and techniques as well as a brief overview of the results produced by various lithotriptors.