We discuss the effectiveness of in situ extracorporeal shock wave lithotripsy (ESWL) for the ureteral stones causing acute renal failure in 5 patients (4 men and 1 woman, mean age 56.2 years). Three of them had a sole functioning kidney, one had a solitary kidney and the other had bilateral ureteral stones. The obstructing stones were located in the upper ureter in one, lower ureter in 2, upper and lower ureter in one and bilateral upper ureter in one with the average length of the stones being 9.2 mm. We used the EDAP LT-01 device for these stones. The obstructing stones were successfully disintegrated by ESWL alone in three cases, but could not be disintegrated in the other 2 cases in which the obstruction had occurred gradually or there were multiple stones. In the latter 2 cases, we performed ESWL again with percutaneous nephrostomy or hemodialysis. We thus believe that ESWL is a safe and effective procedure and is the first choice of emergency treatment for some ureteral stones causing acute renal failure. However, the subject is limited to acute cases, and the stone must be easily detected, single with its size being less than 12 mm and composed of calcium.