Objective To compare the efficacy of the emergency ESWL within 24 hours after the onset of renal colic and elective ESWL at 5 - 7 days after the onset of renal colic in the treatment for ureteral stones.Method From January 2008 to October 2009, 365 patients in the Second Hospital of Nanchang, with ureteral stones were admitted to our department for renal colic. They underwent emergency ESWL or elective ESWL with HK. ESWL- 108 energy electromagnetic shock wave lithotripter. Success rate of fragmentation, stone-free rate after 2 weeks of operation, pain recurrence rate, and complications were evaluated. The data were analyzed using SPSS 15.0. Results The success rate of fragmentation and the stone-free rate after 2 weeks of emergency ESWL were 96.76% and96.21%, respectively, which were higher than those (88.33% and 87.22%, respectively) of elective ESWL ( P ＜ 0. 05). The postoperative pain recurrence rate of emergency ESWL ( 4.32 % ) was lower than that (9.44%) of elective ESWL ( P ＜0.05). There was no difference of total complications between emergency ESWL (3.24%) and elective ESWL (2.78%) group (P ＞0.05). Conclusions Emergency ESWL is superior to selective ESWL and is the safe and effective method for the management of ureteral stones.