Urinary stones are a common urologic emergency that often cause sudden and severe flank pain. The pain typically occurs when a stone moves and irritates the ureter during its passage. In Korea, extracorporeal shock wave lithotripsy (ESWL) has long been considered the standard treatment. However, depending on the size and location of the stone, the procedure may need to be repeated multiple times and its effectiveness can sometimes be limited. To overcome these limitations, endoscopic surgical treatments such as ureteroscopic stone removal (URS) and retrograde intrarenal surgery (RIRS) using a flexible ureteroscope have become increasingly common.
One of the major advantages of endoscopic surgery is its high treatment success rate. URS, which uses a rigid ureteroscope, allows physicians to directly visualize stones in the lower ureter and fragment or remove them using a laser. Even large or hard stones can often be resolved in a single procedure. In contrast, RIRS uses a flexible ureteroscope that can reach deep into the kidney, making it particularly effective for stones located in the upper ureter or kidney that may not respond well to shock wave treatment. Because both procedures allow direct visualization of the stone during treatment, they have a low failure rate and can be applied regardless of stone composition or location.
Endoscopic surgery can also reduce the financial burden on patients by minimizing the need for repeated treatments. According to data from the Health Insurance Review and Assessment Service in Korea, patients undergoing shock wave lithotripsy often require nearly three sessions on average to remove a single stone. Repeated hospital visits and cumulative costs can therefore become significant. In contrast, endoscopic surgery often removes the stone in a single procedure, which may lead to lower long-term medical expenses.
Another advantage of endoscopic surgery is the protection of kidney function. When a stone blocks the ureter for an extended period, it can lead to hydronephrosis or even acute kidney failure. In such cases, immediate endoscopic surgery is often recommended rather than waiting for the stone to pass naturally after shock wave treatment. The American Urological Association (AUA) guidelines also recommend endoscopic surgery as a primary option for upper ureteral stones or in cases where shock wave lithotripsy has failed.
Despite these advantages, the word “surgery” can still feel intimidating for many patients. However, specialists explain that endoscopic stone removal can be compared to removing a polyp during a colonoscopy in terms of procedural burden. Because it does not involve an abdominal incision, recovery is relatively quick. Most patients undergo the procedure under stable general or spinal anesthesia and can usually be discharged within a day after surgery.
There are, however, a few precautions to consider. As the endoscopic instruments pass through the ureter, mild irritation can occur, sometimes resulting in temporary blood in the urine or mild pain. In addition, removing a large stone may cause temporary swelling of the ureter. For this reason, a ureteral stent is often placed temporarily after the procedure. Although the stent may cause some discomfort during urination, it is usually removed easily after one to two weeks. Patients with chronic conditions such as diabetes or hypertension should also undergo careful pre- and post-operative management and consult thoroughly with their medical team.
Dr. Kim Byung-hoon of Goldman Urology Clinic’s Incheon branch explained that protecting kidney function is best achieved by receiving timely professional treatment rather than waiting for urinary stones to pass naturally. He added that patients who experience repeated pain or recurrent stones should consult a urology specialist without delay to receive an accurate diagnosis and appropriate treatment plan.