We have developed several innovative technologies to improve the performance of shock wave lithotripsy, stone fragmentation effiicency and propensity for renal injury. These technologies include ellipsoidal reflector insert for in-situ pulse superposition, secondary shock wave from piezoelectric annulary array for enhanced bubble collapse, gradually increase the output voltage during the lithotripsy procedure, removal of the secondary bubble cavitation around the discharge electrode, clearance of the residual bubble nuclei in the lithotripter field for effective acoustic wave propagation, dynamically splitting and shifting the lithotripter focus with the progress of stone fragmentation, etc. In vivo studies show the renal injury can be reduced by more than 4 fold while in vitro stone phantom fragmentation is increased by 2.6-fold.