Urolithiasis (urinary stones) is a representative urological emergency disease accompanied by sudden, severe flank pain. Specifically, as the stone moves, it irritates the ureter, causing pain. In Korea, Extracorporeal Shock Wave Lithotripsy (ESWL) has long been used as the standard treatment. However, limitations existed, such as the need for multiple procedures or limited effectiveness depending on the size and location of the stone. Recently, endoscopic surgical treatments, such as Ureteroscopic Stone Removal (URS) and Retrograde Intrarenal Surgery (RIRS) using a flexible ureteroscope, are being widely utilized as alternatives to solve these problems.
The first advantage of endoscopic surgery is its high treatment success rate. URS, which uses a rigid ureteroscope, allows for direct visualization of lower ureteral stones and their fragmentation and removal with a laser. This enables the resolution of large or hard stones in a single procedure. On the other hand, RIRS, which uses a flexible ureteroscope, can reach inside the kidney through a flexible endoscope, making it effective for removing stones that are difficult to break with ESWL or those located in the upper ureter. A key strength of both methods is that they involve direct visualization and treatment of the stone, resulting in a low failure rate and applicability regardless of the stone's properties or location.
Furthermore, endoscopic surgery reduces the economic burden as it rarely requires repeated treatments. According to data from the Health Insurance Review and Assessment Service (HIRA), patients with urolithiasis undergoing ESWL require an average of nearly three procedures to remove a single stone. While repeated hospital visits and cumulative costs can inevitably be burdensome, endoscopic surgery offers a high probability of removing the stone in a single procedure, leading to significant long-term healthcare cost savings.
The advantages of endoscopic surgery are also highlighted in terms of kidney function preservation. If a stone obstructs the ureter for an extended period, it can lead to hydronephrosis or acute renal failure; in such cases, immediate endoscopic surgery is recommended rather than waiting for spontaneous expulsion with ESWL. Indeed, the American Urological Association (AUA) guidelines also prioritize endoscopic surgery for upper ureteral stones or cases of ESWL failure.
However, it is also true that the word “surgery” can be burdensome for patients. Regarding this, experts explain that endoscopic stone removal can be understood as a routine procedure, similar in level to removing polyps during a colonoscopy. Since it is not an abdominal incision surgery, recovery is fast, and the majority of patients undergo the procedure under stable general or spinal anesthesia, with discharge possible within a day after surgery.
However, there are a few points to be aware of. First, as the endoscopic instrument passes through and touches the ureteral tissue, temporary hematuria or mild pain may occur. Second, there is a possibility of ureteral edema occurring after the removal of large stones. Therefore, a ureteral stent is often temporarily maintained after the procedure. This stent may cause discomfort during urination but can usually be easily removed after 1 to 2 weeks. Finally, if a patient has chronic diseases such as diabetes or hypertension, pre- and post-operative management is necessary, requiring thorough consultation with the medical team.
Director Kim Byung-hoon of Goldman Urology Incheon Branch stated, “Rather than waiting for urinary stones to disappear naturally, receiving professional treatment at the appropriate time is the most certain way to protect kidney function.” He added, “Patients experiencing recurrent pain or stone recurrence should not delay in seeking a urology specialist for an accurate diagnosis and consultation on the treatment direction.”