Guzel R. et al., 2026: Emergency management of ureteral stones with SWL: is there any advantage over elective approach?

Guzel R, Kanberoglu AF, Yildirim S, Simsek G, Sarica K.
BMC Urol. 2026 Jun 8. doi: 10.1186/s12894-026-02213-2. Epub ahead of print.

 Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Comment Hans-Göran Tiselius

This article is in manuscript form and is told to be in press.

In the title the authors ask the question whether there is an advantage of emergency SWL over elective SWL. According to the result of the study, it probably had been more appropriate to ask if the two methods both were acceptable for ureteral stone removal. The reason for that is that the results in the two groups were similar. The advantage of emergency SWL is that the patient will get rid of the colic pain at an earlier occasion. (<48).

All treatments were carried out with Modulith SLK in which three treatment sessions were allowed at 5-days intervals. Stone-free rates in the emergency group was 65.6% and in the elective group 67.6%. Most surprising is it, however, that eleven patients (34%) in each group of 32 patients required URS as additional stone clearing procedure! That is an outcome that is inferior to what the reviewer expected. It seems possible that the analgesic method with NSAIDs is insufficient for optimal stone disintegration.

Hans-Göran Tiselius