Urinary stone disease, affecting 2–20% of the global population, has shifted from historical open surgical methods to the non-invasive extracorporeal shock wave lithotripsy (SWL), renowned for its efficacy, shorter hospital stays, cost-effectiveness, and lower complication rates. SWL devices play a crucial role in treating urinary stones by applying acoustic vibrations. Key principles such as effective coupling, optimized focus size, progressive energy ramping, and an ideal shock wave frequency significantly impact treatment outcomes. SWL is the primary, non-invasive choice for kidney stones <2 cm, in accordance with EAU guidelines, yet its success depends on stone and patient-related factors. Following SWL, pain is managed with medications, and methods like medical expulsive therapy (MET), movement, and fluid intake enhance stone expulsion. Fourth-week imaging, preferably with computed tomography (CT), is employed for residual stone detection, taking into account radiation exposure. Future advancements in SWL include technologies like the Visio-Track ultrasound system and ultrasonic propulsion, with the aim of improving stone treatment efficacy and reducing radiation exposure.