Retroperitoneal and subcapsular renal hematomas, following extracorporeal shock wave lithotripsy (ESWL) occur rarely, but the large number of this treatment performed has to be considered. The knowledge of risk factors, natural history and compli cations represents a crucial factor in the correct manage ment of these lesions, that generally must be treated con servatively, monitoring clinical parameters and eco-TC dia meters of the hematoma. Surgical approache is indicated only in case of haemodinamic instability not responsive to medical therapy and, after 1-2 months, to try to improve renal disfunction due to compression. In this paper we present a case of retroperitoneal hemato ma after ESWL and review the literature, so as to define the management of these lesions.