Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive medical procedure used to break up kidney stones into smaller fragments that can then be excreted naturally by the body. The shock wave interaction with the stone is usually followed by the growth of cavitation bubbles around the stone, as illustrated in Figure 1. The collapse of these bubbles is an important mechanism that contributes to the fragmentation of the stone, in addition to the mechanical effects resulting from the shock wave-stone interaction1. However, since the cavitation activity is triggered by the shock wave, it is challenging to isolate the role of the cavitation bubbles or the shock waves in the fragmentation of the stone. Such a distinction could nevertheless be achieved by bridging fluid dynamics and solid mechanics, which would allow a deeper understanding of the mechanisms of stone fragmentation. To achieve this, we performed in-situ (ultra-)high-speed X-ray and visible light imaging of shock wave-stone interactions at the ID19 beamline of the European Synchrotron Radiation Facility, using a medical lithotripter to generate the shock waves. These visualizations were complemented by high-resolution post-impact microtomography to assess the location and progression of damage in 3D. We herein report on the propagation of such damages in both phantoms and real kidney stones, with the aim to relate fracture patterns to the different mechanisms of stone fragmentation.