Tile stone fragmentation process induced during Ho:YAG laser lithotripsy was observed by time-resolved flash video imaging. Possible acoustic transient occurrence was simultaneously monitored with a PVDF needle hydrophone, We used artificial and cystine kidney stones. We observed that, although the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has a minimal incidence on stone fragmentation. Fragment ejection is mainly due to a direct laser stone heating and vaporization of stone organic constituents and interstitial water, The minimal effect of the cavitation bubble for fragmentation is confirmed by acoustic transients measurements, which reveal weal; pressure transients. This Is in contrast with the fragmentation mechanisms induced by laser of shorter pulse duration.