Director Lee Chang-ki, Goldman Urology Clinic, Incheon Branch
Urinary stones are a condition that inflicts unbearable pain upon many patients. Recently, various methods have been utilized to treat them. Extracorporeal Shockwave Lithotripsy (ESWL) is one of the commonly used treatment methods for urinary stones, characterized by its non-invasive nature.
Extracorporeal Shockwave Lithotripsy is a non-invasive treatment that uses shockwaves generated by a special electronic device to fragment urinary stones. It typically targets stones larger than 4mm and is primarily used when natural expulsion is difficult due to the stone's size. This treatment method offers the advantages of being simpler for the patient and having a faster recovery time compared to open surgery.
Lithotripters are primarily categorized into spark gap type and magnetic type. The spark gap type generates shockwaves by creating a spark between electrodes in water, and these shockwaves are transmitted to the stone using water as a medium. While this method is powerful, its disadvantages include causing more pain and incurring replacement costs for electrode consumables. In contrast, the magnetic type utilizes an electromagnetic field to generate high voltage and high-frequency vibrations, thereby fragmenting the stones. The magnetic type causes less pain than the spark gap type and has a lower frequency of consumable replacement, leading to less economic burden. While the magnetic type generally involves a higher initial purchase cost for the machine, which can be a burden for hospitals, it can offer economic advantages from the patient's perspective.
While Extracorporeal Shockwave Lithotripsy is a convenient and non-invasive method for treating urinary stones, it is not suitable for all patients. Specifically, in some situations, it may be difficult to apply this treatment immediately. Firstly, caution is required for patients taking anticoagulants such as aspirin. These medications can increase bleeding tendencies, and if lithotripsy is performed, microscopic bleeding from the kidneys or blood vessels may not stop, potentially leading to hematoma formation in the kidney. It is crucial to discontinue such anticoagulants at least one week before proceeding with lithotripsy.
Secondly, patients with long-standing stones are highly likely to experience complications such as complex urinary tract infections or hydronephrosis. This can lead to impaired urine flow due to the stone, causing more significant problems in the kidneys and ureters. In cases accompanied by high fever or severe symptoms of urinary tract infection, inserting a ureteral stent or restoring urine flow by other means should be considered first, rather than lithotripsy.
Thirdly, for stones that are very large or complex in location, making them difficult to treat with lithotripsy, endoscopic surgery is more suitable. Especially for large stones exceeding 1cm or multiple stones, the effectiveness of lithotripsy may be minimal, and a more direct and aggressive endoscopic surgical approach is required to manage such stones.
In addition to pain, urinary stones can cause urinary tract infections or other complications, so it is crucial to receive effective treatment at the appropriate time. The optimal treatment method must be chosen based on the type and location of the stone, as well as the patient's individual circumstances, and in this process, the experience and expertise of the medical staff are extremely important.
When considering treatment for urinary stones, it is essential to understand the various treatment options and determine the most suitable method for each individual patient through professional consultation. When choosing a specialized hospital for urinary stone treatment, it is advisable to review whether there are sufficient treatment references and if both rigid ureteroscopy (URS) for ureteral stone removal and flexible ureteroscopy (RIRS) for renal stone removal are available, in addition to extracorporeal shockwave lithotripsy. If you are suffering from severe pain due to urinary stones, it is strongly recommended to visit a nearby urology department.
Director Lee Chang-ki, Goldman Urology Clinic, Incheon Branch