Background: Ultrasonic and pneumatic lithotripters are the gold standard for percutaneous nephrolithotripsy. The goal of this chapter is to help the reader become more familiar with the newer lithotripters and to critically select the best available lithotripsy device for each situation. Methods: A literature search was performed to identify all types of older and newer generation ultrasonic and ballistic lithotripters. Physics, characteristics, efficacy, and safety are discussed. Results: Newer dual lithotripters are more effective and allow disruption of stones both in the laboratory and clinical trials. CyberWandTM and Lithoclast Select lithotripters have similar stone disintegration rates in percutaneous nephrolithotripsy for stones >2 cm. UrerTron has a very rapid stone clearance rate, especially for hard stones, with no difference in stone clearance rates or need for secondary procedures. Lithoclast® Trilogy demonstrated superior stone clearance time compared to ShockPulse™ and Swiss Lithoclast® Select (Master) with high stone volume clearance rates in both standard and mini PCNL with a mean stone-free rate of 83%. However, more recent data have shown that neither lithotripsy device offers a clinically meaningful advantage over older generation devices. Conclusion: All the new lithotripsy devices have an excellent safety profile. They do not appear to be any more effective than the older generation devices. The advantages, disadvantages, and costs of each type of intracorporeal lithotripter must be considered when choosing a treatment modality for a particular case.