[Emergency extracorporeal shock wave lithotripsy in the treatment of symptomatic ureteral stones].

Purpose: To evaluate efficacy and role of emergency extracorporeal shock wave lithotripsy in the treatment of symptomatic ureteral stones. Methods: Retrospective study which was conducted between July 2007 to July 2008 among 112 patients treated with urgent ESWL treatment of 803 patients treated with ESWL treatment at Urology Clinics of Clinical Center University of Sarajevo. Renal colic was diagnosed on a clinical basis, by ultrasound examination, and by plain x-ray of abdomen. The success rate of ESWL was defined by fragmentation and spontaneous elimination after ESWL treatment. Failed was defined as a need for auxiliary procedures. Results: Mean age of patients was 46,6 years (range 22-65). Male/female ratio was 78/34. Mean stone size was 7,90 mm. Fragmentation after a single session was complete in 62 patients, incomplete fragmentation in 29, and absent in 21 patients. Patients presenting with incomplete fragmentation underwent second (n=29) or even third session (n=17). Of the 21 patients where initial ESWL treatment had no impact on the stone, some underwent a second (n=16) or even a third session (n=11) without success. Of these patients, ureteroscopy was performed in 4 cases, three patients had spontaneous passage of the stones, and ureterolithotomy was performed for 4 patients with impacted stones. The DJ stent was placed for 4 patients due to fever and impossibility to manage the patients medically for the persistent pain. Conclusion: ESWL is a safe, effective, noninvasive method in the treatment of ureteral stones. Stone-free rate for stones in the upper and mid-ureter is above 80%. Stone size may be the main predictive factor for re-treatment. Even complete elimination of the stones is very hard to achieve after single ESWL session - real role of the ESWL treatment for the acute urinary obstruction is to provide ureteral canalization and recover renal function.