“I’ve been told I have a kidney stone, but I don’t feel any pain. Do I really need treatment?”
A man in his early 50s visited a medical clinic after an incidental finding of a kidney stone during a routine health checkup. He had no typical symptoms of urinary stones, such as flank pain or hematuria, and experienced no discomfort in daily life. At a previous clinic, he had been advised that the stone was not large and could be monitored for the time being. However, concerned about potential risks, he sought a more precise evaluation.
Detailed examination revealed a kidney stone measuring over 1 cm. The key issue was not the absence of symptoms, but the change in the stone. Compared to prior imaging, the stone had increased in size and had shifted closer to the ureteral entrance. Although he remained asymptomatic, leaving the stone untreated could lead to sudden severe pain, hematuria, infection, or even impaired kidney function if it obstructed the ureter.
Urinary stones typically originate in the kidney and can cause severe pain as they move through the ureter. However, as in this case, stones that remain within the kidney may not produce noticeable symptoms. This often leads patients to ask whether treatment is necessary if there is no pain. In reality, treatment decisions should not be based solely on symptoms. Factors such as stone size, location, number, and progression over time are critical in determining the appropriate timing for intervention.
Extracorporeal shock wave lithotripsy (ESWL) has long been a standard treatment for urinary stones. While it offers the advantage of being non-invasive, it is not effective for all types of stones. Larger or harder stones, or those located in difficult anatomical positions, may not respond well even after multiple sessions. In clinical practice, it is not uncommon for patients to require additional treatment after undergoing ESWL two or three times.
To overcome these limitations, ureteroscopic stone surgery has become an important treatment option. This minimally invasive procedure involves inserting an endoscope through the urethra and ureter to directly visualize and remove the stone. Depending on the location of the stone, either a rigid or flexible ureteroscope is used. Rigid ureteroscopes are typically used for stones in the lower ureter and allow for efficient fragmentation using larger laser fibers. Flexible ureteroscopes can bend and navigate into the kidney, making them suitable for stones in the upper ureter or within the kidney.
In this patient’s case, the increasing size of the stone and its migration toward the ureter made endoscopic surgery a more appropriate choice than ESWL. The stone was directly visualized, fragmented with a laser, and completely removed without the need for any incision. The patient recovered without complications, and no residual stones remained.
One of the key advantages of ureteroscopic surgery is its high treatment efficiency. Unlike ESWL, which may require multiple sessions, endoscopic surgery allows direct visualization and removal of the stone in a single procedure, reducing the likelihood of retreatment. This approach is particularly beneficial in cases where hydronephrosis is present or where there is concern about declining kidney function, as prompt removal of the obstruction can improve outcomes.
Many patients feel hesitant when they hear the word “surgery.” However, ureteroscopic stone removal is a minimally invasive procedure and can be compared to the removal of polyps during a colonoscopy. If left untreated, urinary stones can lead to recurrent pain and progressive kidney damage. Even in the absence of symptoms, once a stone is identified, it is important to undergo proper evaluation and determine the most appropriate timing and method of treatment.