In theory, except for bleeding disorders that are difficult to control and luminal obstruction distal to the stone, which are absolute contraindications to extracorporeal lithotripsy, all other cases can be performed within the control of extracorporeal lithotripsy. However, in the actual clinical operation, some special cases need to be treated differently. 1. ESWL is preferred for kidney stones ≤2cm in diameter. For kidney stones >2cm, it is recommended to leave a double J tube before lithotripsy to prevent the formation of stone streets blocking the ureter. ESWL is preferred for upper ureteral stones ≤1cm in diameter, and EWSL can be used for upper ureteral stones and middle and lower ureteral stones >1cm in diameter. Contraindications: 1. ESWL is generally not recommended for pregnant women with stones, especially for lower ureteral stones, to avoid adverse effects of shock waves and radiation on the fetus. ESWL can be performed under close control for upper and middle ureteral stones with unbearable pain. 2. Patients with combined diabetes mellitus and uncontrolled disease should not be treated with ESWL to avoid uncontrollable infection after lithotripsy. 3, ESWL treatment is not recommended for patients with severe infection or acute infection to avoid aggravating the infection and triggering bacteraemia, toxemia and the possibility of infectious shock. 4.High risk patients and patients with single or multiple organs not functioning well, such as heart failure, renal insufficiency, isolated kidney or single functioning kidney, etc., can be treated with ESWL in emergency situations when medical conditions can be controlled at that time, and in case of changes in condition, they should be able to be treated in time. 5. Obese patients may not be able to lithotripsy because of difficulty in positioning. 3. Preparation before lithotripsy 1. Do relevant systemic examination, such as blood clotting time, platelet count, liver and kidney function, electrocardiogram, etc. In addition, urinary routine should be done to know whether there is urinary tract infection, and urine culture should be done if necessary. 2.To understand the specific situation of the urinary system (1) KUB: more than 95% of urinary stones are positive stones, and the size, number and specific location of the stones can be understood by KUB. (2) Ultrasound: It can clearly show both negative and positive upper ureteral stones and renal stones, and can also show hydronephrosis, but the detection rate of middle and lower ureteral stones, especially lower stones, is extremely low. (3) Intravenous pyelogram (IVP) and retrograde urography (RGP): IVP can accurately locate stones and is helpful in determining whether they are diverticular stones or whether the calyces are narrowed. In the case of poor renal function, IVP does not reveal the stone, while RGP can effectively show the size and location of the stone and the obstruction. (4) CTU: For more complicated urinary stones, CTU can be used instead of IVP. CTU not only has the luminal system of renal pelvis, calyces, ureter and bladder that IVP can show, but also can show the lesions of renal parenchyma, ureteral wall, bladder wall and surrounding tissues. 3. Other preparations (1) Active infection control: If urinary routine shows significant inflammation, lithotripsy is proposed after inflammation control. (2) Eliminate patient’s tension: generally patients are nervous before treatment, treatment should be done before adequate education, conditions can let patients who have received ESWL treatment to communicate directly with the patient is a good choice to relax tension. (3) Intestinal preparation: Ureteral stones with low density, especially those in the lower and middle segments, can be treated with a laxative to cleanse intestinal gas and feces one day before treatment, which not only facilitates positioning, but also avoids gas accumulation consuming part of the shock wave energy, so that the lithotripsy effect can be optimized. (4) Skin preparation: The pubic hair on the pubic bone should be removed before bladder stone lithotripsy. (5) Pain relief: Nowadays, most of the lithotripters are low-energy lithotripters, and most patients do not need anesthesia for pain relief. For a small number of patients who are sensitive to pain, sedation with Valium and, if necessary, pain relief with Dulcolax are available. Post-lithotripsy treatment and prevention of complications 1. Post-lithotripsy treatment (1) Rest and activity: rest or activity should be decided according to the amount of lithotripsy and whether the lithotripsy is easy to discharge. If the stones are large and the amount of lithotripsy is large, the patient should rest in bed and lie on the affected side for three days after lithotripsy, and should move on the ground as little as possible to slow down the speed of stone removal and avoid or reduce the possibility of stone street formation. For general stone patients ESWL should be more active afterwards to facilitate stone discharge. (2) Drink more water: Drinking more water can increase the urine volume, which is beneficial to stone discharge. (3) Lithotripsy position: Different positions can be used for different parts of the stone to assist stone discharge, and the stone in the lower renal calyx should be discharged in the head ground and foot high position. (4) Drug for stone removal: stone removal granules, kidney stone granules and other traditional Chinese medicine for stone removal. (5) Timing of review: for simple stones, the KUB is generally reviewed about 2 weeks after lithotripsy. For more complicated stones, which are prone to form stone streets, if there is no obvious stone discharge and renal colic occurs, timely consultation should be made. 2. Management of complications after lithotripsy (1) Bleeding: hematuria: almost all patients will have 2-3 times carnal hematuria after lithotripsy, in severe cases the hematuria should disappear by itself in 2-3 days, if hematuria persists, prompt medical consultation should be sought. Perirenal hematoma: It occurs mainly due to impaired coagulation mechanism, uncontrolled hypertension or excessive shock wave energy, and it can also occur when there is intrarenal co-infection. Prevention is achieved by strict control of indications. Subcutaneous hematoma: Petechiae may appear on the skin after lithotripsy, which usually do not require treatment and do not leave scars after healing. (2) Pain: The stone fragments after lithotripsy irritate the ureter and cause renal colic. If the pain is unbearable, it can be treated with antispasmodics or narcotic analgesics, and if the pain is obvious without stone discharge, attention should be paid to the formation of stone streets. (3) Infection: Infected stones can cause infection after lithotripsy due to the release of bacteria in the stone, which can cause infectious shock in serious cases possibly. Preventive measures are to strictly control urinary tract infection before lithotripsy and to give appropriate anti-inflammatory treatment after lithotripsy.