Introduction. Shock wave lithotripsy (SWL) is considered the first choice in the treatment of renal-ureteral lithiasis. In addition to known contraindications, there are also factors that impede the SWL procedure - obesity, ureteral calculi at the level of the iliosacral ligament, radiotransparent calculi in the upper and middle ureter, and skeletal deformities. Overcoming these factors increases the possibilities of applying ESWL. In the Urology and Nephrological Surgery Clinic at USMF « Nicolae Testemițanu,» alternative patient positioning options have been proposed during SWL procedures. The patient’s position is in semi-decubitus dorsal-lateral and lateral (with an adjusted degree of «inclination» in relation to the surface of the table). Material and methods. A total of 628 patients treated with ESWL using the modified position were evaluated at the Urology Clinic from 2017 to 2022. ESWL was performed with the MODULITH SLK «Storz Medical» lithotripter. Patients were divided into groups: those with radionegative calculi in the upper ureter and morbid obesity - 386 cases (group 1), and those with radiopaque ureteral calculi located in the projection of the iliosacral ligament - 242 cases (group 2). Results were evaluated according to the «stonefree » rate, the need for other treatment methods, and complications. All patients were reexamined after five days of ESWL. Results. Group 1 - «Stone free» after the first SWL session was achieved in 257 patients (65.5%). Ureteroscopy was performed in 42 patients (10.8%). Retroperitoneal hematoma occurred in one patient (0.3%). Group 2 - «Stone free» after the first SWL session was achieved in 194 patients (80%). Ureteroscopy was performed in 11 cases (4.5%). Repeated lithotripsy sessions were performed in 124 patients from both groups. Conclusions. Alternative patient positioning allows for the extended application of ESWL in iliosacral, radiotransparent upper ureteral calculi, and obesity with equal efficacy. The results obtained are comparable to data from specialized publications.