Objective  To evaluate the efficacy and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of acute renal colic caused by ureteral calculi.Methods  Pubmed, Embase, Cochrane Library, Wanfang and CNKI databases were searched from establishment to December 2021, and clinical studies on eESWL and dESWL in the treatment of acute renal colic caused by ureteral calculi were searched. Review Manager 5.4.1 software was used to analyze the retrieved results.Results  A total of 602 patients were included in 6 literatures. The results of Meta-analysis showed that the postoperative stone clearance rate in the eESWL group was higher than that in the dESWL group (OR=2.03，95%CI：1.33～3.08，P<0.001), and the re-treatment rate in the eESWL group was lower than that in the dESWL group (OR=0.38，95%CI：0.23～0.61，P<0.001). The results of subgroup analysis showed that there was no significant difference in postoperative stone clearance between the two subgroups (P>0.05).Conclusions  Emergency extracorporeal shock wave lithotripsy is a safe and successful treatment for acute renal colic caused by ureteral stones.