Urinary stones can develop anywhere along the urinary tract, including the kidneys, ureters, and urethra. If treatment is delayed, the condition may lead to complications such as urinary tract infections, hydronephrosis, and decreased kidney function. For this reason, early diagnosis and appropriate treatment are important.
In the past, treatment options for urinary stones depended largely on the size and location of the stone. Methods such as extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) were commonly used. Smaller stones were often treated by applying shock waves from outside the body to break them into fragments that could pass naturally through urine. Larger stones, typically over 10 mm, sometimes required surgical access to the kidney through the skin. With advances in endoscopic technology, ureteroscopic surgery using a holmium laser has become widely used, allowing more precise treatment with faster recovery.
Although the holmium laser is effective for directly fragmenting stones, it also has limitations. During laser application, stone fragments may scatter or migrate upward along the ureter, a phenomenon known as retropulsion. When stones move back into the kidney, capturing and removing them again can be time-consuming and technically challenging. Longer procedures can increase anesthesia exposure for patients and lead to greater fatigue for the surgical team.
To address these limitations, a technology known as the Moses system has been introduced. The Moses system is based on a dual-pulse laser principle. The first laser pulse separates water molecules and creates a temporary channel, allowing the second pulse to reach the stone with minimal energy loss. This approach improves energy delivery efficiency, increases fragmentation power, and reduces the likelihood that stones will be pushed away during treatment.
Another advantage of the Moses system is the vortex effect generated during laser emission, which helps stabilize the stone in place. By reducing stone movement, the system can shorten both fragmentation and removal time.
More recently, suction-assisted ureteroscopy has also attracted attention. In conventional ureteroscopic surgery, stones are first fragmented with a holmium laser and then individually retrieved using a basket device attached to the endoscope. When stones are large, the process can take one to two hours or even require multiple procedures.
Suction ureteroscopy is designed to simultaneously fragment and remove stone debris. As the laser breaks the stone, the fragments are immediately suctioned out, reducing the need for repeated manual retrieval. This approach can shorten both surgical time and anesthesia duration. The suction mechanism also helps maintain a clearer surgical field by removing blood or small stone fragments that may otherwise obscure visibility. Improved visualization allows for more precise manipulation and can enhance the overall stone clearance rate.
Despite these technological advancements, prevention and long-term management remain essential for urinary stone disease. Adequate hydration is the most fundamental measure, and drinking at least two liters of water per day is generally recommended. Keeping urine diluted helps prevent stone formation. Reducing excessive intake of salty foods and animal protein while maintaining a balanced diet is also important. Individuals with a family history of stones or a previous history of the condition should undergo regular checkups for early detection.
Dr. Min Seung-gi of Goldman Urology Clinic’s Jamsil branch explained that the treatment of urinary stones requires an integrated approach that addresses pain control, prevention of complications, and reduction of recurrence risk. He noted that technologies such as the Moses system and suction ureteroscopy represent significant advancements, improving both the precision and efficiency of modern stone surgery.