1 3 Urolithiasis DOI 10.1007/s00240-016-0879-4 ORIGINAL PAPER Effect of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones Oktay Ucer 1 · Yasin Ceylan 2 · Fatih Ekren 3 · Erol Ozan 4 · Talha Muezzinoglu 1 Received: 28 January 2016 / Accepted: 22 March 2016 © Springer-Verlag Berlin Heidelberg 2016 anxiety and pain in the women were higher than the men. SFR of SWL in the men was higher than the women. The severity of anxiety and pain in the patients may affect SFR of SWL. Keywords SWL · Anxiety · Pain · Stone · Ureter · Renal pelvis Introduction Shock wave lithotripsy (SWL) has become a safe and accepted treatment for urinary tract stones since its intro- duction in the early 1980s [1]. The European Association of Urology Guideline on Urolithiasis (limited updated March 2015) recommended SWL as the primary treatment for renal pelvic and proximal ureteral stones of <20 mm [2]. Because SWL has the advantages of being minimally invasive, lacks severe undesirable side effects, and does not require the use of general anesthesia, it has gained wide- spread acceptance and use for treating urinary tract stones in certain areas [3]. As our understanding of SWL has increased, many factors have been identified that can effect treatment out- comes. Some studies investigated some factors associated with stone, including volume, location, density, composi- tion and multiplicity [4, 5]. Other studies evaluated the other factors that can affect on the success of SWL, includ- ing skin-to-stone distance, model of lithotripters and differ- ent shockwave delivery [6–8]. The hypothesis of the present study was that anxiety and pain perception of patients could affect the compliance of them during SWL. Therefore, anxiety and pain could be possible factors affecting stone free rates (SFRs) in the patients treated by SWL. Abstract The aim of this study is to evaluate the impact of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones smaller than 15 mm. One hundred thirty-two patients with proximal ureteral or renal pelvic stones <15 mm who were treated by a SWL and forty controls were enrolled in the study. State-trait anxiety inventory (STAI) was used to assess anxiety of the controls and patients (before every SWL session). Pains of the patients were measured by a visual analog scale (VAS) at three times (T) of the sessions (T11 at 11 kV, T15 at 15 kV and T end of treatment). The mean STAI scores of the patients at the first SWL session and controls were 40.61 ± 8.71 and 36.11 ± 8.18, respec- tively (p < 0.05). There was statistically positive moderate relationship between STAI and VAS scores at the first SWL session. The mean size of stone in men and women were 11.16 ± 2.88 and 11.00 ± 3.41, respectively (p = 0.88). In the first session, the mean STAI and VAS scores of the men were significantly lower than the women. The stone-free rate (SFR) of SWL was 72.7 % in this study. The SFR of SWL in the men and women were 78 and 64 %, respec- tively (p < 0.05). Our data showed that the severity of * Oktay Ucer uceroktay@yahoo.com 1 Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey 2 Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey 3 Urology Clinic, Private Batı Urology Branch Center, Manisa, Turkey 4 Department of Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey