One of the representative diseases that comes to mind when thinking of urology is urolithiasis. In fact, urolithiasis is a very common disease, accounting for 25% of hospitalized patients in urology departments. Generally, the number of patients gradually increases from early summer in May as temperatures rise, thus requiring special attention.
In Korea, extracorporeal shock wave lithotripsy (ESWL) is the most commonly used method for treating urolithiasis. The problem is that, precisely because ESWL is the most frequently utilized treatment for urolithiasis, it has given rise to several misconceptions.
The most common misconception is that receiving extracorporeal shock wave lithotripsy just once can completely break down and resolve all stones. However, in reality, the success of ESWL can vary significantly depending on the stone's composition, size, location, and other factors. In fact, according to statistics from the Health Insurance Review and Assessment Service (HIRA), the average number of ESWL procedures per stone is close to three. This means that, on average, a stone is resolved after undergoing ESWL approximately three times.
Therefore, if stones occur in areas difficult to remove with lithotripsy, or if stones are too large or too small, multiple stones are present, or hard stones that cannot be broken by lithotripsy occur, endoscopic surgery may be more effective. The Health Insurance Review and Assessment Service (HIRA) also recommends surgical treatment more strongly if there is no change whatsoever after approximately three sessions of extracorporeal shock wave lithotripsy.
Furthermore, not all patients are immediately eligible for extracorporeal shock wave lithotripsy. Lithotripsy cannot be attempted immediately for patients with certain conditions. For example, patients with a bleeding tendency or those taking anticoagulant medications such as aspirin may face an increased risk of complications like hematoma or hemorrhage due to ESWL. In such cases, medication should be discontinued before undergoing lithotripsy.
Patients with implanted pacemakers, those who are pregnant, or very elderly patients are not suitable candidates for extracorporeal shock wave lithotripsy due to the increased possibility of side effects. Additionally, overweight or obese patients present a challenge because the shock waves must travel a greater distance. Instead, the shock waves may be absorbed by body fat, which can reduce the effectiveness of extracorporeal shock wave lithotripsy. In other words, it can be concluded that not all patients are suitable candidates for ESWL.
Director Kim Jae-woong of Goldman Urology Clinic, Gangnam Branch, stated, "There are many natural misconceptions about extracorporeal shock wave lithotripsy that arise from the desire to quickly resolve urolithiasis, which causes unimaginable pain." He added, "If you are suffering from urolithiasis pain, I recommend visiting a nearby urology department for thorough examination and personalized treatment."
Medical Today Reporter Jo Seong-woo ()