The present invention provides enhanced ESWL efficacy for therapeutic and operational outcomes. Device behavior and performance data is measured in-situ and analyzed for both intra-procedure and inter-procedure breadth of regard such that both therapy optimization and maintenance optimization engines are provided an accurate and current assessment of ESWL system and device state and performance. This feedback and control provides the ability to compensate in real time for the current patient therapy and offline for future patient therapy for machine/therapy idiosyncrasies and realize continuous calibration of system/devices to the performance required for maximum ESWL patient efficacy.