One of the most well-known conditions associated with urology is urinary stone disease. In fact, urinary stones are extremely common and account for about 25% of hospitalized patients in urology departments. The number of patients typically begins to increase gradually from May, when temperatures start to rise, so additional caution is recommended during this period.
In Korea, extracorporeal shock wave lithotripsy (ESWL) is the most commonly used treatment for urinary stones and accounts for more than 70% of all stone treatments. This contrasts with Europe and the United States, where ESWL accounts for less than 50% of stone treatments. Because ESWL is the most frequently used treatment method, there are also several misunderstandings among patients that should be clarified.
One of the most common misconceptions is the belief that a single session of extracorporeal shock wave lithotripsy can completely break and remove all stones. In reality, the success of ESWL can vary greatly depending on several factors, including the composition, size, location, and number of stones. According to statistics from the Health Insurance Review and Assessment Service (HIRA) in Korea, the average number of ESWL sessions required per stone is close to three. This means that, on average, patients often require approximately three treatments before the stone is fully resolved.
In certain situations, other treatment approaches may be more effective. For example, endoscopic surgery may be recommended when stones occur in locations that are difficult to treat with ESWL, when stones are extremely large or very small, when multiple stones are present, or when the stone composition is too hard to be fragmented by shock waves. HIRA guidelines also suggest that if there is no change in the stone after approximately three ESWL treatments, surgical treatment may be more appropriate. For instance, in one clinical case involving a radiolucent giant upper ureteral stone, the stone remained after an initial ESWL treatment at another clinic. The patient later visited our hospital and was successfully treated with retrograde intrarenal surgery (RIRS).
It is also important to note that not all patients are suitable candidates for extracorporeal shock wave lithotripsy. In some cases, the procedure cannot be performed immediately due to medical conditions that increase the risk of complications. For example, patients with bleeding tendencies or those taking antiplatelet medications such as aspirin may have an increased risk of bleeding or hematoma formation after ESWL. In such cases, these medications may need to be temporarily discontinued before treatment can be safely performed.
Patients who have implanted cardiac pacemakers, women who are pregnant, or patients of very advanced age may not be appropriate candidates for ESWL due to the increased risk of complications. In addition, the effectiveness of shock wave lithotripsy may be reduced in overweight or obese patients because the shock waves must travel a longer distance and may be partially absorbed by body fat before reaching the stone. For these reasons, ESWL is not the optimal treatment option for every patient with urinary stones.
In this article, we have addressed several common misconceptions surrounding extracorporeal shock wave lithotripsy. Many of these misunderstandings arise from the understandable desire to resolve the severe pain caused by urinary stones as quickly as possible. If you are experiencing symptoms related to urinary stones, it is recommended that you visit a nearby urology clinic and receive appropriate evaluation and treatment.
As people enter middle age and beyond, urologic conditions become increasingly common. By providing useful information about urinary diseases that interfere with daily life, the goal is to help individuals maintain a healthier and more comfortable quality of life.