Perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) is an unusual but underdiagnosed complication. Most hematomas are asymptomatic, but severe complications are possible, which may require intervention such as a blood transfusion. We present the case of a 41‑year‑old Asian man suffering from a symptomatic huge perirenal/subcapsular hematoma with scrotal hematoma after ESWL; we reviewed the literature and examined the possible risk factors and treatments. This case was a very rare presentation of hematoma extension into the scrotum region from an ipsilateral perirenal hemorrhage caused by shock wave lithotripsy treatment.