Dr. Lee Chang-gi, Director of Goldman Urology Clinic Incheon Branch
Urinary stones are known to cause extremely severe pain for many patients. In recent years, various treatment methods have been used to manage this condition. One of the most commonly used approaches is extracorporeal shock wave lithotripsy (ESWL), which is characterized as a non-invasive treatment.
Extracorporeal shock wave lithotripsy is a non-invasive method that uses shock waves generated by a specialized electronic device to break urinary stones into smaller fragments. It is generally used for stones larger than 4 mm, particularly when natural passage is difficult due to the size of the stone. Compared with open surgery, this treatment is relatively simple from the patient’s perspective and offers a faster recovery time.
Lithotripters are mainly divided into two types: spark gap type and magnetic type. The spark gap type generates shock waves by creating a spark between electrodes in water, and the shock waves are transmitted through water to the stone. This method is powerful but tends to cause more pain and requires periodic replacement of electrode consumables.
In contrast, the magnetic type uses an electromagnetic field to generate high voltage and high-frequency vibrations, which are then used to break the stone. Compared with the spark gap type, the magnetic system generally causes less pain and requires fewer consumable replacements, reducing long-term costs. Although the magnetic system typically has a higher initial purchase cost for hospitals, it can provide economic advantages from the patient’s perspective.
While extracorporeal shock wave lithotripsy is convenient and non-invasive, it is not suitable for every patient. In certain situations, the procedure may not be immediately applicable.
First, caution is required for patients taking anticoagulant medications such as aspirin. These medications increase the tendency for bleeding, and performing lithotripsy in such cases may cause persistent micro-bleeding in the kidney or blood vessels, potentially leading to a renal hematoma. For this reason, anticoagulants such as aspirin should generally be discontinued at least one week before undergoing the procedure.
Second, patients with long-standing stones may develop complications such as urinary tract infection or hydronephrosis. In such cases, the stone can obstruct urine flow, causing more serious problems in the kidney or ureter. If high fever or severe urinary infection symptoms are present, restoring urine flow—such as by inserting a ureteral stent—should be considered before lithotripsy.
Third, when stones are very large or located in complex positions, lithotripsy may be less effective and endoscopic surgery may be more appropriate. For example, stones larger than 1 cm or multiple stones often respond poorly to shock wave treatment, and more direct endoscopic procedures may be required.
Urinary stones can cause not only severe pain but also complications such as urinary tract infections, making timely and appropriate treatment important. The optimal treatment method should be selected based on the stone type, location, and the patient’s individual condition. In this process, the experience and expertise of the medical team play a critical role.
When considering treatment for urinary stones, it is important to understand the available treatment options and determine the most suitable approach through professional consultation. When choosing a specialized clinic for urinary stone treatment, patients should review whether the facility has sufficient clinical experience and whether it can provide not only extracorporeal shock wave lithotripsy but also procedures such as ureteroscopic stone removal (URS) and retrograde intrarenal surgery (RIRS).
Dr. Lee Chang-gi of Goldman Urology Clinic Incheon Branch advises that patients experiencing severe pain due to urinary stones should visit a nearby urology clinic for proper evaluation and treatment.