This is a real time image of ESWL showing fragmentation of a kidney stone into fine powder.
This procedure is being performed on the state of the art Dornier Compact Delta ESWL machine. The ESWL if scrupulously done can avoid PCNL and subsequent RIRS in significant number of cases.
The most important thing for ESWL success is choosing right case (Naveen et al. WCE 2004 .Predicting factors for ESWL), continuous real time image monitoring by trained professional, under anaesthesia cover (compromised intensity for pain can have compromised outcome too...).