Emergency management of ureteral stones with SWL: is there any advantage over elective approach?

The optimal timing of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones remains unclear. This study aimed to compare the clinical and radiological outcomes of emergency versus elective ESWL in patients presenting with ureteral calculi.

In this retrospective study, 66 patients who underwent ESWL at our institution between June 2023 and December 2024 were included. Patients were categorized into emergency (n = 32) and elective (n = 34) ESWL groups. All procedures were performed using a Modulith SLK Inline lithotripter (Storz Medical, Switzerland) with up to 3,000 shocks per session at 60–90 shocks per minute under NSAID analgesia. Demographic characteristics, stone-related parameters (size, volume, density), procedural variables (session number, duration), stone-free (SF) rates, post-procedural emergency visits, and infectious complications were analyzed. Stone-free status was assessed 7 days after the final ESWL session.

There were no significant differences between the emergency and elective groups regarding age, sex, body mass index (BMI), or comorbidities. Stones in the emergency ESWL group were significantly larger (8.2 ± 2.65 mm vs. 7.7 ± 1.74 mm; p = 0.023) while stone volume was similar. The number of ESWL sessions and total procedure duration did not differ significantly. Stone-free rates were comparable between groups (65.6% vs. 67.6%; p = 0.862). Post-treatment emergency department visits (31.3% vs. 20.6%; p = 0.322) and infectious complications (15.6% vs. 5.9%; p = 0.199) did not differ significantly.

Emergency ESWL was associated with stone-free rates comparable to elective ESWL in carefully selected patients, despite a larger mean stone size in the emergency ESWL group. However, the numerically higher infectious complication rate in the emergency group warrants cautious interpretation. These findings suggest that emergency ESWL may represent a feasible early treatment option for selected patients with symptomatic ureteral stones.