One of the most commonly associated conditions with urology is urinary stones. In fact, urinary stones are a very common condition, accounting for about 25 percent of hospitalized patients in urology departments. The number of patients typically begins to increase gradually from early summer, around May, when temperatures rise, so extra caution is needed during this period.
In Korea, extracorporeal shock wave lithotripsy (ESWL) is the most commonly used treatment for urinary stones. However, because it is so widely used, several misconceptions about the procedure have also developed.
One of the most common misunderstandings is the belief that a single session of ESWL can completely break and remove all stones. In reality, the success of ESWL can vary greatly depending on factors such as the stone’s composition, size, location, and other conditions. According to statistics from the Health Insurance Review and Assessment Service in Korea, the average number of ESWL treatments per stone is close to three. This means that, on average, patients may require about three treatment sessions for the stone to be fully resolved.
Therefore, in cases where stones are located in areas that are difficult to treat with shock wave therapy, when stones are extremely large or very small, when multiple stones are present, or when the stones are particularly hard and resistant to fragmentation, endoscopic surgery may be a more effective treatment option. In fact, the Health Insurance Review and Assessment Service also recommends considering surgical treatment when there is no improvement after approximately three sessions of ESWL.
In addition, not every patient is immediately eligible for ESWL. Certain conditions make the procedure less suitable. For example, patients with bleeding tendencies or those taking antiplatelet medications such as aspirin may face a higher risk of complications, including bleeding or hematoma formation during ESWL. In such cases, the medication may need to be discontinued before undergoing the procedure.
Patients with implanted cardiac pacemakers, pregnant women, or extremely elderly patients may also not be suitable candidates for ESWL due to a higher risk of side effects. Furthermore, overweight or obese patients may experience reduced treatment effectiveness because shock waves must travel a longer distance through body tissue, and some of the energy may be absorbed by body fat. In other words, ESWL is not the most appropriate treatment for every patient.
Dr. Kim Jae-woong of Goldman Urology Clinic’s Gangnam branch explained that many misunderstandings about ESWL arise from patients’ understandable desire to quickly relieve the severe pain caused by urinary stones. He advised that anyone experiencing symptoms of urinary stone pain should visit a nearby urology clinic for proper evaluation and personalized treatment rather than relying on assumptions about the procedure.