title: Prospective randomized evaluation of emergency extracorporeal shock wave lithotripsy (ESWL) on the short-time outcome of symptomatic ureteral stones.
abstract: OBJECTIVE
  Here, we report the results of a randomized controlled trial (RCT) assessing the efficacy of emergency ESWL (eESWL) on the short-term outcome of symptomatic ureteral stones.
  
  
  METHODS
  The trial enrolled 100 patients admitted in emergency room for renal colic caused by a ureteral radioopaque [corrected] stone. Patients were randomized to medical therapy alone or combined with eESWL. eESWL was performed within 6 hours of the onset of renal colic without specific analgesia on a Lithostar lithotripter (Siemens Medical, Munich, Germany). The primary endpoints were the proportion of patients stone free rate after 48 hours (SF-48) and the cumulative proportion of patients discharged from the hospital after 48 and 72 hours.
  
  
  RESULTS
  Ureteral stone's location was proximal and distal in respectively 46% and 54% of the patients; stone's mean size was 5.5 mm (range 2-10 mm). Median hospital stay was 3 days, ranging from 1 to 14 days. SF-48 in the control group varied from 76% for distal stones <5 mm to 28.6% for proximal stones >5 mm, averaging at 61%. On average, eESWL increased SF-48 by 13% (p: 0.126), the gain strictly depending on stone size and location. SF-48 increase ranged from 40% for proximal stones >5 mm to 1.8% for distal stone <5 mm. On average, eESWL increased the median duration of hospital stay by one day. This mean negative impact results from ESWL increasing significantly the duration of hospital stay in case of distal stone, while slightly shortened it for stones located proximally.
  
  
  CONCLUSIONS
  This study demonstrated for the first time that rapidly performed ESWL is a valuable therapeutic option to improve elimination of ureteral stones and shorten duration of hospital stay, proven that the stone is located proximally to the iliac vessels.
authors.affiliation: Service d'Urologie, UCL Saint Luc, Avenue Hippocrate, 10, B-1200 Brussels, Belgium. bertrand.tombal@fymu.ucl.ac.be
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tombal
authors.forename: Hadi
authors.initials: H
authors.lastname: Mawlawi
authors.forename: Axel
authors.initials: A
authors.lastname: Feyaerts
authors.forename: Francois X
authors.initials: FX
authors.lastname: Wese
authors.forename: Reinier
authors.initials: R
authors.lastname: Opsomer
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Van Cangh
mesh_terms: D000328:Adult; D004630:Emergencies; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*