Emergency ESWL in ureteral lithiasis

Abstract

Extracorporeal shock wave lithotripsy (ESWL) may be considered first-choice treatment for upper ureteral stones; for lower ureteral stones, an endoscopie approach gives a high success rate but also higher morbidity. Over a period of 18 months in our Department, 275 consecutive patients with ureteral stones underwent ESWL. In 40 patients (14.5%) ESWL was performed within 48 hours of onset of acute renai colie; stone diameters were 7.5 mm average (range 5-20 mm). Ten patients (25%) were treated after ultrasonography and abdomen X-rays, while 30 patients also underwent an I.V.P. Shock waves required for fragmentation were 1503 on average (range 437-2650). All patients were treated after sedation-analgesia. All patients had remission of clinical symptoms after ESWL and one month later were all stone-free at X-ray and ultrasonographic control. Just one complication was observed: a small perineal hematoma that required no treatment. On the basis of our data, emergency ESWL is suggested as a non-invasive, easy-to-perform, well-tolerated treatment giving immediate remission of clinical symptoms. When unsuccessful, it does not preclude endoscopy or open surgery. Emergency ESWL has proved to be the treatment of choice due to the high percentage of total stone elimination, lack of anesthesia, few complications and excellent patient compliance.