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Shock wave lithotripsy (SWL) has revolutionized the calculus treatment, but it also produces acute renal injury. If the stone is larger than 20 mm or located in anatomically difficult locations, SWL is poor and even fails. This work aims to increase stone fragmentation while reducing simultaneously the propensity of injury in SWL. First, large intraluminal bubble expansion was found to constitute a mechanism of SWL-induced vascular injury. In situ pulse superposition technique was then developed by fitting an insert with the lithotripter reflector. It could significantly reduce the propensity...