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Objective: This study aimed to evaluate the practice of extracorporeal shockwave lithotripsy (ESWL) treatment from different aspects (indications, technical, and equipment-related characteristics) through a questionnaire response by the experienced endourologist in the European centers. Materials and Methods: A survey of 72 questions on four main topics was prepared by our team to evaluate the demographics of technical equipment, treatment applications, and pretreatment preparations. The survey was mailed to 200 endourologists, of whom 97 academic endourologists enrolled, 75% of them were from university or training hospitals and 69% have experience of >10 years in urology. Results: Of the urologist, 74% had direct access to ESWL-device, and the endourologist was mainly responsible for the ESWL unit with the 61% rate and was secondly the technician, which was trained on ESWL (25%). The factors that affect the decision for ESWL include the stone's size, location, density, composition, and kidney anatomy. Stone density was the most preferred for the ESWL decision and the cut-off value was <1000 hounsfield unit for the 71% of endourologists. Increased oral hydration and medical expulsive treatments were commonly used and recommended after the ESWL session. Routine antibiotic prophylaxis was not used by most of the endourologists (45%), and ureteroscopy (39%) was the most responded approach after steinstrasse formation. Conclusion: Survey answers revealed that most of the experienced European endourologists decide to treatment alternatives following the suggested guidelines and ESWL is still a valuable option for urinary stone treatment. [ABSTRACT FROM AUTHOR]