Jain J. et al., 2026: Extracorporeal shockwavelithotripsy vs ureteroscopy for management of acute ureteric colic due to stones: A randomized controlled trial.

Jain J, Navriya SC, Chintapalli RC, Choudhary GR, Singh M, Bhirud DP, Sandhu AS.
World J Crit Care Med. 2026 Jun 9;15(2):114619. doi: 10.5492/wjccm.v15.i2.114619

Abstract

Background: Urolithiasis is one of the most prevalent condition with evolving management strategies. While extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) are common minimally invasive treatments, their comparative efficacy, safety, and impact on quality of life (QoL) require continuous evaluation.

Aim: To compare the clinical efficacy, safety, patient satisfaction, and economic outcomes of ESWL vs URSL in the management of lower ureteric stones.

Methods: This randomized controlled trial included 240 adult patients with confirmed lower ureteric calculi, allocated equally to ESWL or URSL groups. Baseline characteristics, stone parameters, procedural details, complications, and follow-up outcomes - including stone clearance, pain, QoL, workdays lost, cost, and satisfaction - were systematically analyzed over a 3-month follow-up.

Results: URSL demonstrated significantly higher stone-free rates at all time points (e.g., 95% at 3 months) compared to ESWL (55.83%). While ESWL was associated with fewer complications, it required more sessions and resulted in lower immediate postoperative QoL and higher workdays lost. Conversely, ESWL was more cost-effective and highly satisfactory, with better early pain scores. Stone size and density influenced success, favoring URSL for larger or denser stones. Overall, both modalities are effective, but treatment choice should be individualized based on stone characteristics and patient factors.

Conclusion: URSL offers superior stone clearance, particularly for larger stones, with acceptable safety profiles. ESWL remains a viable non-invasive option for smaller stones, providing better QoL recovery and economic benefits. Individualized treatment planning is essential for optimal outcomes.

Comment Peter Alken

A very comprehensive, high-quality study containing many details. However, information regarding the time interval between the colic episode and the treatment is missing. Treatment outcomes deteriorate as the time elapsed increases. The results for SWL are particularly poor.

See also (1-3).

1 Peng, C.X., et al. Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis. BMC Urol, 2023. 23: 56. https://www.ncbi.nlm.nih.gov/pubmed/37016405

2 Beaujouan F, Panthier F, Traxer O, Descazeaud A, Kutchukian S, Chicaud M. Safety and effectiveness of external shock wave lithotripsy in emergency: A narrative review. Fr J Urol. 2025 Jun;35(5):102866. doi: 10.1016/j.fjurol.2025.102866. Epub 2025 Feb 12. PMID: 39952565.

3 Guzel R, Kanberoglu AF, Yildirim S, Simsek G, Sarica K. Emergency management of ureteral stones with SWL: is there any advantage over elective approach? BMC Urol. 2026 Jun 8. doi: 10.1186/s12894-026-02213-2. Epub ahead of print. PMID: 42260532.

Peter Alken