In the last few years dramatic changes have occurred in the surgical treatment of stones in the upper urinary tract. Ninety-five per cent of all stones that previously necessitated open surgery are now amenable to less invasive techniques. Percutaneous nephrolithotomy (PCNL), developed in the early 1980s, has been complemented by extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopy (URS). This article traces the history of ESWL, defines its place in the management of patients with upper urinary tract stones, and looks forward to further advances.