© 2015 OMU.The aim of the study is to evaluate extracorporeal shock wave lithotripsy (ESWL) related alterations in renal pelvis and proximal ureter by using histopathological methods and analayting hydroxy-proline levels. Twelve New-Zealand rabbits were allocated into two groups (n=6). Right sites of control group (CG, n=6) were harvested without any intervention. In ESWL group (EG), right kidneys of subjects were exposed to 3000 shock waves (14 kV) by using electro-hydraulic type ESWL device three times. Rabbits in EG were sacrificed on day 7. Tissues were examined histopathologically for presence of edema, inflammation, congestion, hemorrhage, fibrosis, vascularization and biochemically for hydroxyproline concentrations. Histopathologically, tissue edema was increased in renal pelvises and inflammation was increased in ureters in the EG compared to that in the CG (p<0.5). There was no difference in other parameters between the groups (p>0.05). Tissue collagen density did not show any significant difference (p>0.05). There was no difference in the tissue hydroxyl-proline levels of ureter samples (p>0.05). Tissue hydroxyproline levels were significantly higher in EG than CG in renal pelvis (p<0.05). In conclusion, although no major histopathological alteration due to ESWL was detected in renal pelvis and proximal ureter, increased hydroxyproline levels in the renal pelvis can be suggested as a finding of tissue injury in collecting system.