Abstract: Extracorporeal shock wave lithotripsy (ESWL) is a mostsuccessful application of shock wave and its focusing technique in clinicalfields. Because of its non-invasive nature, high patient comfortableness and highlithotripsy efficiency with lower costs, this treatment has been at theforefront of treatment of kidney stones. But there are some shortcomings,such as lower lithotripsy efficiency for big stones, short- or long-term sideeffects, nonreversible loss of organ functions. The process ofstone disintegration and concomitant tissue injury caused by actions in ESWL is very complicated.To maximize the effect of stone disintegration and minimizethat of tissue damage, the theoretical study of ESWL, both laboratorial and clinical, hasbeen carried out along with the invention and the improvement of ESWL.Today the mechanism of stone comminution and tissue damage is muchbetter understood, but some important aspects remain to be cleared.While the direct mechanisms of stone comminution and tissue trauma offocusing shock waves are better understood now, its indirect mechanism, the cavitation induced by shockwaves, is not very clear and is still a challenge and a hotspot ofthe researches on ESWL. The standard on the efficiency and the securityof ESWL is in a process of improvement.