included abnormally elevated renal parameters, signs of a concomitant infectious process (fever, leukocytosis, or a positive urine dipstick), pain poorly responding to analgesia, radiolucent stones, or stones smaller than 4-mm or larger than 15-mm in size. 72 patients had been randomly assigned to undergo ESWL directly without pre-stenting (Group A), while 52 patients were assigned for pre-stenting (Group B), with their data and outcomes prospectively collected. Mean patient BMI in both groups was 26.1 and 26.7 kg/m2 (p ¼ 0.49), mean skin-to-stone dis- tance was 11 and 10.1 cm (p ¼ 0.03), mean stone size was 7.3 and 7.8 mm (p ¼ 0.114), and mean stone density was 902 and 1078 Hounsfield units (p ¼ 0.005) respectively. RESULTS: 72 patients had undergone emergency ESWL directly without pre-stenting (Group A), while 52 patients had un- dergone pre-stenting before emergency ESWL (Group B). All 124 patients had their first session of ESWL done within 48 hours of their initial presentation. 8 patients were lost to follow up in Group A, while one patient was lost to follow up in Group B. Four patients’ stones had migrated to the kidney with stenting and were excluded from the study. Stone clearance in both groups was 61% and 44% (p ¼ 0.068) after one session, 91% vs 59% (p ¼ <0.001) by the second session, and 95% and 73% (p ¼ 0.001) by the third and last session. No patients in Group A crossed over to Group B or required stenting at any point. CONCLUSIONS: Emergency ESWL for upper ureteric calculi offers excellent stone clearance outcomes for properly selected patients with an acute presentation of renal colic that has subsided. Proceeding directly for ESWL without pre-stenting was associated with significantly enhanced stone clearance while sparing the patient multiple invasive interventions and their potential morbidity. Source of Funding: none MP62-16 SHOCK WAVE LITHOTRIPSY IS EFFICACIOUS FOR TREATING OBESE PATIENTS WITH UPPER URETERIC CALCULI : 5 YEAR PROSPECTIVE OUTCOMES FROM A DEDICATED CENTRE TREATING PATIENTS WITH A SKIN-TO-STONE DISTANCE OF MORE THAN 14CM William KM Gietzmann, Abishek Sharma, Edward Mains, ismail El-Mokadem, Ben G Thomas, Simon Phipps, David A Tolley, Mark L Cutress*, Edinburgh, United Kingdom INTRODUCTION AND OBJECTIVES: Obesity is increasingly common and often a predisposing factor in stone formation. Clinical reviews and guidelines indicate that SWL outcomes are poor for treating stones in patients with skin-to-stone distance (SSD) of >10- 14cm, and regard a large SSD as an adverse predictor for SWL success (EAU Urolithiasis Guidelines 2016). There is a paucity of literature on treating such patients with SWL, and given the higher recognised perioperative morbidity of surgery in such a population, and the potential benefits of sedo-analgesia and short length of stay with ambulatory SWL, it is germane to re-evaluate the efficacy of SWL for treating such patients using a lithotriptor with a focal length of >14cm. METHODS: Consecutive patients with a solitary radio-opa- que upper ureteric calculus diagnosed on CT scan with a SSD 14cm were identified from a prospective database (2011-2016). Out-patient SWL was performed under sedo-analgesia (diclofenac  alfentanil) using a Sonolith I-Sys, EDAP-TMS (focal depth 17cm). Outcome was assessed with an XRKUB at 2 weeks. Those with significant fragments (>3mm) received further treatment. Success was defined as patients being free of stones on XRKUB or as having asymptomatic clinically insignificant stone fragments (CISF) 3mm. Failure was defined as residual fragments >3mm (treated with ureteroscopy). RESULTS: 182 patients met the inclusion criteria. 4 were lost to follow up. Median age was 54 years. Median stone size was 8mm (range 3-21). Overall stone-free rate (SFR) was 81% after mean 1.3 sessions. 63% were stone-free after a single session. 9% had CISF3mm. 11% required ureteroscopy. CONCLUSIONS: SWL can provide efficacious treatment of upper ureteric stones in obese patients, traditionally thought to be poor candidates for such treatment due to their high SSD. The upper threshold of SSD for SWL selection should be revised, as such pa- tients can receive the benefits of effective SWL treatment, without the need for general anaesthesia, when referred to a dedicated stone centre. Source of Funding: none MP62-17 LISTENING TO MUSIC DURING SHOCK WAVE LITHOTRIPSY DECREASES ANXIETY, PAIN AND DISSATISFACTION: A RANDOMIZED CONTROLLED STUDY Ozgur Cakmak, Izmir, Turkey; Sertac Cimen, Halifax, Canada; Huseyin Tarhan, Mugla, Turkey; Rahmi Gokhan Ekin, Batuhan Ergani, Taha Cetin, Volkan Ulker, Ilker Akarken, Zafer Kozacioglu*, Izmir, Turkey INTRODUCTION AND OBJECTIVES: We analyzed the effects of music on pain, anxiety and overall satisfaction in patients undergoing shock wave lithotripsy (SWL) procedure. METHODS: Two hundred patients scheduled for SWL were prospectively enrolled in this study. Group 1 consisted of 95 patients who listened music during the SWL procedure while 105 patients in group 2 did not listen music during the treatment. Anxiety of the patients were measured according to State-Trait Anxiety Inventory (STAI). STAI-T (Trait) was completed only before the procedure, whereas STAI-S (State) was completed both before and after SWL. Pain, patient satisfaction and willingness to repeat procedure were evaluated after SWL using a visual analog scale (VAS). Hemody- namic parameters including sistolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured before and after procedure. RESULTS: Group 1 consisted of 95 (47.5%) patients while group 2 included 105 (52.5%) patients. No statistically significant difference was found between two groups in terms of stone char- acteristics, SWL parameters, STAI-T and STAI-S scores and he- modynamic parameters before SWL. Pre-SWL hemodynamic parameters, STAI-S and STAI-T scores of the study groups are displayed in Table 1. After SWL completed, STAI-S scores were found to be lower in patients who listened music (p¼0.006). At the end of the SWL, VAS scores of pain, satisfaction and willingness to repeat procedure were significantly different in favour of music group (p¼0.007, p¼0.001, p¼0.015, respectively). SBP, DBP and HR were found significantly higher in patients who did not listened music (p¼0.002, p¼0.024, p<0.001, respectively). Post-SWL hemody- namic parameters, STAI-S scores and VAS scores are shown in Table 2. CONCLUSIONS: Music can be an ideal adjunctive treatment modality for patients undergoing SWL treatment. It has the potential to enhance patient compliance and treatment satisfaction by reducing the procedure-related anxiety and pain perception. Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017 THE JOURNAL OF UROLOGY â e833