Urolithiasis refers to all types of stones that form within the urinary system. It is commonly known to originate in the kidneys, characterized by its movement along the ureters, bladder, and urethra, obstructing the flow of urine and causing pain in the surrounding areas. In this process, it can lead to complications such as urinary tract infection (UTI), hydronephrosis, and even kidney failure.
When urolithiasis occurs, extracorporeal shock wave lithotripsy (ESWL) is typically the first treatment attempted. ESWL does not require hospitalization or anesthesia, and patients can usually resume their daily activities within about an hour after the procedure. However, not all stones can be resolved with ESWL. Cases where complications such as kidney failure, hydronephrosis, or urinary tract infection have developed are prime examples.
Endoscopic surgery should be considered when kidney failure, characterized by impaired kidney function, occurs. Extracorporeal shock wave lithotripsy is a method that involves fragmenting stones with shock waves and then allowing them to pass naturally with urine. However, if kidney function is compromised, urine flow is often poor, making natural stone expulsion difficult.
If a urinary tract infection occurs, it is advisable to remove the stone in a single procedure before the inflammation worsens. Therefore, considering ureteroscopic stone removal instead of extracorporeal shock wave lithotripsy is an effective approach.
Secondly, for special types of stones such as radiolucent stones, bilateral ureteral stones, or multiple stones, ureteroscopic stone removal should be considered. In the case of radiolucent stones, they are not visible on X-rays. This makes it difficult to perform extracorporeal shock wave lithotripsy, which relies on X-ray fluoroscopy for treatment guidance. For bilateral ureteral stones, where both left and right ureters are simultaneously obstructed, it is a dangerous situation that can lead to acute kidney failure if urine is not expelled from both sides. Therefore, it is difficult to wait for two or three sessions of lithotripsy to be completed.
Furthermore, if there are multiple stones in one ureter (multiple calculi), even if one stone is fragmented, the remaining stones will still be present, making natural expulsion difficult. Therefore, in such cases, it is more advisable to proceed with ureteroscopic stone removal rather than extracorporeal shock wave lithotripsy.
If the stone size is large, exceeding 1 cm, proceeding directly with endoscopic surgery may be more effective. For large stones measuring 1 cm or more, the probability of successful fragmentation with a single session of extracorporeal shock wave lithotripsy is significantly low. This means that multiple lithotripsy sessions would be required. However, considering the impact on the body, ESWL can only be performed with an interval of about five days to a week between sessions. Consequently, the treatment period inevitably becomes prolonged. During this time, the large stone continues to obstruct the ureter, leading to a continuous decline in kidney function and persistent severe pain. Therefore, for large stones exceeding 1 cm, endoscopic surgery for single-session removal is faster and more effective.
Director Kim Byung-hoon of Goldman Urology Clinic, Incheon Branch, stated, "Urolithiasis causes severe pain comparable to that of childbirth. Therefore, if extracorporeal shock wave lithotripsy has not been effective, I recommend considering ureteroscopic stone removal, which can remove the stone in a single procedure." He added, "With recent advancements in surgical equipment, including rigid and flexible endoscopes, safer and more effective surgeries are now possible."