This clinical trial compares two techniques of extracorporeal shock wave lithotripsy (ESWL) - energy ramping versus fixed dose - in adult patients with renal stones. The study aims to evaluate stone-free rates, retreatment needs, and safety outcomes across multiple clinical sites in Egypt.

This multi-center, randomized controlled trial investigates the impact of energy ramping versus fixed-dose ESWL on stone clearance in patients with solitary renal calculi. Participants will be assigned to either a gradually increasing energy protocol or a constant energy protocol using standardized lithotripter settings. The primary outcome is stone-free rate at two weeks post-treatment, assessed via imaging. Secondary outcomes include retreatment rate, pain scores, adverse events, and procedure duration. The study is conducted under IRB approval from Sohag University and follows international ethical standards for human research.

Inclusion Criteria:

• Adults ≥18 years.
• Radiopaque renal or proximal/mid ureteral stone ≤20 mm.
• eGFR ≥60 mL/min/1.73 m².
• Fit for ESWL.
• Able to give informed consent and complete follow up.

Exclusion Criteria:

• • Pregnancy.

  • Active, untreated UTI.
  • Uncorrected bleeding disorder or anticoagulation that cannot be stopped.
  • Prior ipsilateral renal surgery.
  • Non radio-opaque stone without reliable imaging.
  • Inability to tolerate ESWL or required anesthesia.