Extracorporeal shock wave lithotripsy (ESWL) is recognized as a safe, non-invasive, and effective treatment for urolithiasis. The procedure typically performed under sedation or adequate pain control. This study aims to compare the treatment outcomes and the safety of ESWL between patients receiving intravenous (IV) sedation and local analgesia and to analyze the result based on patient characteristics.

We retrospectively analyzed all patients who received ESWL at out institution (China Medical University Hospital, Taichung, Taiwan) between December 2022 and July 2023. Outcomes assessed included the 30-day post-ESWL re-intervention rate, 3-day emergency department visit rate, subcapsular hematoma formation, and changes in glomerular filtration rate (GFR). These outcomes were compared between patients receiving intravenous sedation or local analgesia. Subgroup analysis was done based on patient characteristics such age, gender, BMI, systemic diseases, coagulation profile.

A total of 407 patients who received ESWL for urolithiasis were included in the final analysis. Of the 205 patients who underwent IV sedation and the 198 patients who underwent local analgesics, there were no statistically significant differences between the two groups in terms of post-ESWL re-intervention rates, ED visit rates, or changes in GFR. However, there was a statistically significant difference in the rate of symptomatic hematoma formation between the two groups.

IV sedation and local analgesia provide comparable effectiveness in terms of ESWL treatment outcomes, including re-intervention rates, emergency visits, and renal function. However, the significantly higher incidence of symptomatic subcapsular hematoma in the local analgesia group suggests a potential safety concern, highlighting the need for further study and careful patient selection.