A 43-year-old male patient visited our hospital after receiving extracorporeal shock wave lithotripsy (ESWL) four times at another clinic without successfully removing his urinary stone. Initially, the stone was located at the point where the ureter begins at the kidney. After multiple ESWL treatments, the stone had moved approximately 3 cm downward along the ureter. However, the stone measured 11 mm, which is relatively large, and the repeated ESWL treatments had not been effective. For this reason, ureteroscopic stone removal surgery was recommended. The procedure was successful, and the patient was discharged on the same day with a ureteral stent in place. This case demonstrates that when urinary stones cannot be effectively treated with ESWL, ureteroscopic stone removal should be considered as an alternative treatment.
Urinary stones refer to the formation of mineral deposits within the urinary tract, including the kidneys, ureters, bladder, or urethra. Urinary stones are known to cause extremely severe pain, often described as comparable to the pain experienced during childbirth. The most common symptom is intense flank pain, which can feel like a sharp stabbing sensation in the side of the abdomen and may occur intermittently. This pain occurs because the stone moves along the urinary tract, triggering strong muscular contractions in the ureter that produce severe pain in the surrounding tissues. Other symptoms may include frequent urination, urinary urgency, a sensation of incomplete bladder emptying, blood in the urine, nausea or vomiting, and abdominal bloating.
When a stone is small and there is no significant swelling in the surrounding tissue, conservative treatment—such as increased water intake and observation—may be recommended to allow the stone to pass naturally. If this approach is not effective, extracorporeal shock wave lithotripsy is usually the first treatment attempted. However, some stones cannot be successfully treated with ESWL. Stones larger than approximately 1 cm, multiple stones, or stones that are particularly hard may not break easily with shock wave treatment. If a patient undergoes ESWL about three times without improvement, ureteroscopic stone removal surgery should be considered. Continued pain can be extremely difficult for patients to tolerate, and leaving the condition untreated may lead to complications such as hydronephrosis, in which the kidney becomes swollen due to urine buildup.
Some patients worry about the pain associated with endoscopic surgery because they feel anxious about urologic procedures performed through the urinary tract. However, endoscopic treatment for urinary stones has been performed for many years and has become increasingly refined with advances in medical technology. Today, very thin rigid endoscopes and flexible endoscopes that can bend smoothly and reach the kidney through the urethra are commonly used. These advancements have reduced the physical burden of the procedure.
Compared with open surgery, endoscopic surgery is considered minimally invasive. It generally places less strain on the body and can often be performed under spinal anesthesia or lower-body anesthesia rather than general anesthesia. As a result, the risk of complications and postoperative side effects may also be reduced.
Ureteroscopic stone removal surgery has a high success rate of approximately 97%. Although results may vary depending on individual patient conditions, this procedure is often highly effective for patients who do not respond to extracorporeal shock wave lithotripsy. Urinary stones should not be ignored, as untreated stones can eventually damage kidney function. According to data from the Health Insurance Review and Assessment Service (HIRA), the number of patients with urinary stones in Korea has increased by 13.9% over the past five years. Because urinary stones are becoming more common, individuals who experience symptoms suggestive of the condition are encouraged to consult a urology specialist for evaluation and treatment.
As men 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.