“I’ve been told there are stones, but there’s no pain at all. Do I really need treatment?”
A, a office worker in his early 50s, visited a medical institution after unexpectedly hearing about kidney stones during a health checkup. There were no typical urinary stone symptoms such as flank pain or hematuria, and there was no discomfort in daily life. At the medical institution he had visited before, he was told, "The size is not very large, so let's just watch for now." However, because he was worried about potential risks, he requested a consultation for a more accurate evaluation.
As a result of a precise examination, stones larger than about 1cm were confirmed in A's kidneys. The problem was not pain, but change. The stones had grown in size compared to past tests, and their location was also moving toward the entrance of the ureter. Although there are currently no symptoms, if left in this state, there was a sufficient possibility that the stones would block the ureters, leading to sudden extreme pain, hematuria, infection, and decreased renal function.
Urolithiasis is a disease that causes severe pain as it starts in the kidneys and moves along the ureters. However, like A, there are many cases where there are no specific symptoms while staying in the kidneys. For this reason, the question "Can't I not treat it if it doesn't hurt?" often comes up. However, it is difficult to judge whether to treat urolithiasis by the presence of pain alone. The size, location, number of stones, and the pattern of change over time are core factors in determining the timing of treatment.
In Korea, Extracorporeal Shock Wave Lithotripsy (ESWL) has been used as a representative method of urolithiasis treatment for a long time. It has the advantage of fragmenting stones without incision, but it is not effective for all stones. For large or hard stones, or stones in difficult positions, there are many cases where they are not removed even after repeating the procedure several times. In actual clinical practice, it is common to experience cases where additional treatment is needed even after performing ESWL 2-3 times or more.
The treatment method that complements these limitations is urolithiasis endoscopic surgery. It is a method of inserting an endoscope through the ureter to directly check and remove stones, using a rigid ureteroscope or a flexible ureteroscope depending on the location of the stone. Rigid ureteroscopes are suitable for lower ureteral stones because they are sturdy and linear in structure, and can use relatively thick lasers, shortening stone removal time. On the other hand, flexible ureteroscopes can be moved freely, so they can approach the inside of the kidney and be utilized for the treatment of upper ureteral or kidney stones.
In A's case, since the stone size was growing and the possibility of moving to the ureters was high, it was judged that endoscopic surgery was more suitable than ESWL. Using an endoscope, stones were directly checked and then fragmented and removed with a laser, and the procedure was performed without incision. Afterward, all remaining stones were removed, and he recovered without any special complications.
Urolithiasis endoscopic surgery has high treatment efficiency in that it can remove stones in one session. Unlike ESWL, which can be repeated several times, it can reduce the possibility of re-treatment because stones are removed while checking with eyes. Especially if there is already hydronephrosis or if there is a concern about decreased renal function, it is advantageous in terms of prognosis to quickly remove stones with endoscopic surgery rather than delaying treatment.
Many patients feel burdened by the word surgery. However, urolithiasis endoscopic surgery is a minimally invasive treatment that removes stones while directly looking at them, which can be understood similarly to the process of removing polyps during a colonoscopy. Urolithiasis is a disease that can lead to decreased renal function as well as repetitive pain if left untreated. If stones are found even if there are no symptoms, it is important to determine the timing and method of treatment through accurate evaluation.