Since the early 1980s extracorporeal shock-wave lithotripsy (ESWL) has become the primary treatment modality for urinary stone disease [1]. Renal stones are fragmented by high-energy shock waves [2] or by the impingement of cavitation microjets [3, 4] into small pieces and are passed spontaneously. Because of the differences in chemical compositions and structural features of renal calculi [5], shock wave-stone interaction during ESWL [6], and thus the efficacy of stone fragmentation, may vary significantly. Clinically, among common stone types, phosphate (struvite and calcium apatite) stones are found to be easy to fragment, whereas uric acid and brushite stones are in the middle range, and calcium oxalate monohydrate and cystine stones are the most resistant types to ESWL therapy [7-9]. To improve the efficacy of ESWL treatment, it is desirable to identify the physical properties of renal calculi that can offer direct correlation with their fragilities during ESWL and thus can be used to guide treatment procedures for more effective stone fragmentation. The fracture toughness of renal calculi offers a direct measurement of stone resistance to fracture failure during ESWL. In this letter we report our results for the fracture toughness of renal calculi of various compositions. A microindentation technique was used to determine stone hardness. An ultrasound transmission technique was used to measure both longitudinal and transverse wave speeds, from which the Young's and shear moduli of stone materials were derived. Based on these measurements and the lengths of crack lines produced by the hardness indentor, the fracture toughness of renal calculi were calculated and compared with stone fragility obtained from previous studies [7-9]. Implications of the measurement results on an improved understanding of the mechanism of stone fragility and on enhancing the effectiveness of stone fragmentation during ESWL are discussed. Six stone specimens with crystal compositions determined by crystallographic analysis (Urolithiasis Laboratory, Baylor College of Medicine, Houston, Texas, USA) were used. The densities of the specimens were determined using a pycnometer (2 ml in capacity) based on ~ Archimedes' principle [6]. Stone specimens were mounted in a self-curing cold-mounting material (Koldmount, VernonBenshoff Co., New York, USA), polished and prepared for microhardness measurement as described in [10]. Ten indentations were made in homogeneous crystalline regions of each specimen using a Vickers indentor at a load of 50 g with a dwell time of 15 s. Since renal calculi are essentially brittle materials, radial cracks (Fig. 1) were formed along the diagonals of the indentation after unloading [10]. The lengths of these crack lines reflect the degree of elastic recovery of the material and can be used to determine the fracture toughness of the stone [11]. We measured the crack length (c) and the size of indentor impression (l), and calculated the fracture toughness (Kic) for the stone material using [11]