Extracorporeal shockwavelithotripsy vs ureteroscopy for management of acute ureteric colic due to stones: A randomized controlled trial

doi:10.5492/wjccm.v15.i2.114619

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Publication Name

World Journal of Critical Care Medicine

ISSN

2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Crit Care Med. Jun 9, 2026; 15(2): 114619
Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.114619

Extracorporeal shockwavelithotripsy vs ureteroscopy for management of acute ureteric colic due to stones: A randomized controlled trial

Jaydeep Jain, Shiv C Navriya, Ravi Chandra Chintapalli, Gautam R Choudhary, Mahendra Singh, Deepak P Bhirud, Arjun S Sandhu

Jaydeep Jain, Shiv C Navriya, Ravi Chandra Chintapalli, Gautam R Choudhary, Mahendra Singh, Deepak P Bhirud, Arjun S Sandhu, Department of Urology, All India Institute of Medical Sciences, Jodhpur 342008, Rājasthān, India

Co-corresponding authors: Shiv C Navriya and Ravi Chandra Chintapalli.

Author contributions: Jain J, Navriya SC, and Chintapalli RC made substantial contributions to the acquisition and interpretation of data, contributed to the study concept; Navriya SC and Chintapalli RC contributed equally to this article, they are the co-corresponding authors of this manuscript; Navriya SC, Choudhary GR, Singh M, and Bhirud DP critically reviewed the manuscript; Chintapalli RC, Singh M, and Bhirud DP agreed to be accountable for all aspects of the work; and all authors have read and approved the final manuscript.

AI contribution statement: AI tools (specifically ChatGPT and Grammarly) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.

Institutional review board statement: This study was approved by the Medical Ethics Committee of All India Institute of Medical Sciences, approval No. ALLMS/IEC/2023/9514.

Clinical trial registration statement: This study was approved by All India Institute of Medical Sciences, approval No. CTRI/2024/12/078043.

Informed consent statement: The patient has given informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Data can be shared.

Corresponding author: Shiv C Navriya, Adjunct Associate Professor, Consultant, Department of Urology, All India Institute of Medical Sciences, Faculty Quarters, Jodhpur 342008, Rājasthān, India. drshivnavriya2004@gmail.com

Received: September 24, 2025
Revised: November 11, 2025
Accepted: February 2, 2026
Published online: June 9, 2026
Processing time: 239 Days and 14.3 Hours

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.

Keywords: Acute renal colic; Lower ureteric calculi; Ureteroscopic lithotripsy; Extracorporeal shock wave lithotripsy; Stone-free rate; Cost-effectiveness; Quality of life; Complications

Core Tip: Management of acute colic due to lower ureteric calculi requires balancing stone clearance, patient comfort, and treatment costs. Ureteroscopic lithotripsy achieves higher stone-free rates and patient satisfaction, especially in larger or complex stones, whereas extracorporeal shock wave lithotripsy remains a less invasive, cost-effective option suitable for smaller stones. Treatment should therefore be individualized, considering stone characteristics, patient preferences, and resource availability.