The first clinical experiences with extracorporeal shockwave lithotripsy (ESWL)--the method of choice in noninvasive treatment of renal calculi--were so encouraging that more ESWL units are now being installed and a still larger number can be predicted. A cost-efficiency analysis shows that, in spite of high investment costs, a net saving of about DM 4,599 (deutsche marks) can be figured for each 'ESWL patient' compared to the expenses of an open operation. This benefit is due to the reduction of disability time, hospital stay and dialysis cases. For the management of an ESWL unit a trained team of urologists and anesthesiologists, as well as a clinic with an 'operative background' is necessary.