--- title: Korea's kidney stone surgery changed over eight years. Its imaging changed nearly five times faster publication: Medical Insights Korea section: news category: Kidney Stones canonical_url: https://medicalinsightskorea.com/news/korea-kidney-stone-imaging-outran-the-surgery author: Andrew Cho published: 2026-09-10T15:00:00+09:00 modified: 2026-09-10T15:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Korea's kidney stone surgery changed over eight years. Its imaging changed nearly five times faster Shockwave lithotripsy is still the operation Korea performs most for urinary stones. The scan that finds them rose 394.8 percent — in a disease that recurs, in patients who are mostly of working age. ## Answer Between 2009 and 2016 the surgical treatment of urinary stones in Korea shifted towards endoscopy without abandoning shockwave lithotripsy — shockwave rose 16 percent from 89,553 to 104,013 procedures a year and remained the commonest by a wide margin, while ureteroscopic lithotripsy rose 97 percent, percutaneous nephrolithotomy 99.7 percent and flexible ureteroscopy sixteen-fold from a small base of 219 to 3,712 — but the largest change over the same period was diagnostic rather than operative: non-contrast computed tomography recorded in stone diagnostic codes rose 394.8 percent and contrast-enhanced computed tomography 263.3 percent, while intravenous pyelography fell 26.2 percent, which matters because urinary stones recur, because Korean emergency departments saw 120,647 stone patients in 2016 alone, and because the national cohort data show the disease concentrated in working men rather than in the elderly. ## Key takeaways - Shockwave lithotripsy remains Korea's commonest stone operation, rising 16 percent from 89,553 procedures in 2009 to 104,013 in 2016. - Endoscopic treatment grew far faster in relative terms: ureteroscopic lithotripsy up 97 percent to 12,057, percutaneous nephrolithotomy up 99.7 percent to 1,835, and flexible ureteroscopy up sixteen-fold from 219 to 3,712. - The largest single change was in imaging. Non-contrast computed tomography in stone diagnostic codes rose 394.8 percent and contrast-enhanced computed tomography 263.3 percent, while intravenous pyelography fell 26.2 percent. - Korean emergency departments recorded 103,981 urolithiasis patients in 2014, 112,083 in 2015 and 120,647 in 2016. Of those, 13.2 percent were admitted. - Emergency visits peaked in August at 35,927 in a month against 24,008 in February, and clustered at weekends and around 6 a.m. and 8 p.m. - In 33,078 stone analyses between 2014 and 2019, calcium oxalate was the largest group at 46.41 percent, followed by struvite at 29.66 percent, uric acid at 19.61 percent and calcium phosphate at 4.32 percent. - Composition shifts with age: calcium oxalate falls as patients get older while uric acid rises, so the same diagnosis in a 30-year-old and a 70-year-old is often a different stone. - In the national sample cohort, the age-standardised incidence ratio was 1.14 in workers overall and 1.19 in paid employees against the non-working population — the burden sits on people of working age. ## Full article Two changes happened to urinary stone care in South Korea between 2009 and 2016, and only one of them was an operation. Endoscopic surgery grew quickly, from a small base, without displacing the treatment it was supposed to be replacing. Meanwhile the scan used to find the stone in the first place rose by nearly 400 percent, which is the larger change and the one that has attracted less attention. ### What the operating figures show A national population-based study drew on claims submitted to the Health Insurance Review and Assessment Service across those eight years. Outpatient and inpatient episodes for urinary stone disease both rose significantly over the period. - Shockwave lithotripsy: 89,553 procedures in 2009, 104,013 in 2016, a rise of 16 percent. - Ureteroscopic lithotripsy: 6,106 to 12,057, a rise of 97 percent. - Percutaneous nephrolithotomy: 919 to 1,835, a rise of 99.7 percent. - Flexible ureteroscopic lithotripsy: 219 to 3,712, a sixteen-fold rise. The sixteen-fold figure is the one that gets quoted, and it is worth reading carefully. Flexible ureteroscopy grew from 219 procedures nationally to 3,712 — a genuine transformation of a technique, and still around a thirtieth of the shockwave total at the end of the period. Korea did not swap one operation for another over these eight years. It added endoscopic capability alongside a shockwave practice that kept growing. ### The change that outpaced all of them Set against those surgical numbers, the diagnostic ones move differently. **+394.8%** — non-contrast computed tomography recorded in urinary stone diagnostic codes, 2009 to 2016; contrast-enhanced computed tomography rose 263.3 percent while intravenous pyelography fell 26.2 percent _Source: Kim JK et al., International Journal of Urology, 2019_ Non-contrast computed tomography is the better test. It finds stones intravenous pyelography misses, it takes minutes, and in an emergency department full of people in acute flank pain that is not a marginal advantage. The substitution is clinically sound and the falling pyelography figure is the evidence it happened. What makes the size of the rise worth stating separately is the disease it is being used on. Urinary stones recur. A patient who forms one is likely to be scanned more than once, and each scan is a dose. > **Why recurrence makes an imaging figure a clinical one** > A single computed tomography scan is a reasonable trade for a diagnosis. The question a national figure raises is different: it is about the same patients returning. Korea's own 2023 guideline from the Korean Society of Endourology and Robotics divides the natural history of urolithiasis into active treatment and silent phases, which is a way of saying the disease persists between episodes. Nothing in these claims data measures cumulative dose per patient, and no study cited here attempts it. That is the gap, not a finding — and it is the study worth doing. ### Who is being scanned The national emergency department information system recorded 103,981 urolithiasis patients in 2014, 112,083 in 2015 and 120,647 in 2016. Of those patients, 13.2 percent were admitted, a rate that stayed stable across the three years. Admission was more likely at the two ends of life, in patients under nine and over seventy, and in those on medical aid. The timing is seasonal and daily at once. August was the heaviest month at 35,927 visits against February's 24,008, and visits clustered at weekends and around 6 a.m. and 8 p.m. — a distribution that matches a stone passing during the night or on a day off rather than during a working appointment. Who forms them is the part that changes how the imaging figure reads. In the National Health Insurance Service national sample cohort covering 2002 to 2015, prevalence was significantly higher in workers than in non-workers, particularly men. The age-standardised incidence ratio was 1.14 in workers overall, 1.19 in paid employees and 1.08 in the self-employed, each against the non-working population. That is a working-age disease with a long recurrence horizon, which is exactly the population in whom cumulative imaging accumulates. ### Not every stone is the same stone A companion dataset from the Korean Society of Endourology and Robotics research series analysed 33,078 stone compositions collected between January 2014 and June 2019. Calcium oxalate was the largest group at 46.41 percent, followed by struvite at 29.66 percent, uric acid at 19.61 percent and calcium phosphate at 4.32 percent. Composition varied by sex, region, month and season — calcium oxalate peaked in summer and fell in spring — and it varied with age in opposite directions: calcium oxalate declined as patients got older while uric acid rose. A stone in a man in his thirties and a stone in a man in his seventies are frequently not the same chemical problem, and prevention that ignores the difference is prevention aimed at the wrong mechanism. ### What the figures do and do not settle These are claims and registry data. They count procedures, diagnostic codes and emergency attendances, and they do so across an entire national population, which is their strength. They cannot say whether an individual patient was scanned appropriately, how much radiation any one person accumulated, or whether the endoscopic shift improved stone-free rates, because none of those is a field in a claim. What they do establish is the shape of the practice. Korea treats a very large number of stones, increasingly with endoscopes but still mostly with shockwaves, in a population weighted towards working men, and it finds them with a scan whose use grew far faster than any operation over the same period. ## Sources - Kim JK, Cho YS, Park SY, Joo KJ, Min SK, Lee YG, Han JH. Recent surgical treatments for urinary stone disease in a Korean population: national population-based study. International Journal of Urology 2019;26(5):558-564. doi:10.1111/iju.13928. PMID:30803067. https://doi.org/10.1111/iju.13928 - Kim JW, Kim JY, Ahn ST, Oh MM, Moon DG, Park HS. Analysis of patients with urolithiasis visiting the emergency department between 2014 and 2016 in Korea: data from the National Emergency Department Information System. Scientific Reports 2019;9(1):16630. doi:10.1038/s41598-019-52950-8. PMID:31719555. https://doi.org/10.1038/s41598-019-52950-8 - Jung HD, Seo IY, Lee JY. Large database study of urinary stone composition in South Korea: Korean Society of Endourology and Robotics (KSER) research series. Investigative and Clinical Urology 2021;62(4):462-469. doi:10.4111/icu.20210039. PMID:34190438. https://doi.org/10.4111/icu.20210039 - Heo J, Son J, Lee W. Epidemiology of urolithiasis with sex and working status stratification based on the national representative cohort in Republic of Korea. Safety and Health at Work 2022;13(4):482-486. doi:10.1016/j.shaw.2022.07.002. PMID:36579016. https://doi.org/10.1016/j.shaw.2022.07.002 - Jung HD, Lee JY, Kang DH, Ko K, Koh DH, Kwon O, Koo KC, Kim KT, et al. Korean Society of Endourology and Robotics (KSER) recommendation on the diagnosis, treatment, and prevention of urolithiasis. Investigative and Clinical Urology 2023;64(4):325-337. doi:10.4111/icu.20230102. PMID:37417557. https://doi.org/10.4111/icu.20230102 ## Citation Andrew Cho (2026). "Korea's kidney stone surgery changed over eight years. Its imaging changed nearly five times faster". Medical Insights Korea. https://medicalinsightskorea.com/news/korea-kidney-stone-imaging-outran-the-surgery Retrieved from https://medicalinsightskorea.com/news/korea-kidney-stone-imaging-outran-the-surgery