Energy Ramping Versus Fixed Dose ESWL

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.