--- title: About one Korean in nine will form a urinary stone. One in five of them will form another within five years publication: Medical Insights Korea section: news category: Kidney Stones canonical_url: https://medicalinsightskorea.com/news/korea-urolithiasis-lifetime-risk-and-recurrence author: Andrew Cho published: 2026-09-11T09:00:00+09:00 modified: 2026-09-11T09:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # About one Korean in nine will form a urinary stone. One in five of them will form another within five years Two national cohort studies of the same decade agree on the lifetime risk and disagree on whether the disease is still spreading. The number that decides what happens after the pain stops is neither of those. ## Answer In a National Health Insurance Service national sample cohort of about one million Koreans followed from 2002 to 2013, the standardised lifetime prevalence of urolithiasis was estimated at 11.5 percent overall — 12.9 percent in men and 9.8 percent in women — the eleven-year cumulative incidence was 5.71 percent, and 21.3 percent of diagnosed patients had a recurrence within five years, which means roughly one Korean in nine forms a urinary stone at some point in life and about one in five of those forms another inside five years. ## Key takeaways - The standardised lifetime prevalence of urolithiasis in Korea was estimated at 11.5 percent — 12.9 percent in men and 9.8 percent in women — in a National Health Insurance Service national sample cohort of about one million people. - Over the eleven years from 2002 to 2013 the cumulative incidence was 5.71 percent, 7.07 percent in men and 4.34 percent in women, and was highest in the 60-to-69 age group at 9.08 percent. - 21.3 percent of patients diagnosed with urolithiasis had a recurrence within five years. - A second study of the same national sample cohort found the annual incidence stable at 3.27 per 1,000 person-years while prevalence rose from 3,172 cases in 2002 to 5,758 in 2013, with peak incidence at ages 45 to 49 and a male-to-female ratio of 1.57 to 1. - Incidence varied by province: highest in Jeollanam-do at 3.70 per 1,000 person-years and lowest in Jeju at 2.84, with Daegu highest among men at 4.56. - Age over 60, income level, diabetes, body mass index, hypertension and a cancer history were identified as contributing factors in the cumulative-incidence analysis. - The 2024 European Association of Urology guideline update recommends baseline metabolic screening for every stone patient and two 24-hour urine collections for calcium-stone formers at high risk of relapse. ## Full article A urinary stone is usually explained to a patient as an episode. The national data describe it as a condition. The distinction decides what happens after the pain stops — whether the encounter ends at the discharge desk or opens a follow-up that runs for years. ### How many Koreans this happens to A study published in the Journal of Korean Medical Science drew on the National Health Insurance Service national sample cohort — roughly one million people, followed from January 2002 to December 2013. Over those eleven years the database recorded 57,921 diagnosed cases of urolithiasis. **Urolithiasis in the NHIS national sample cohort, 2002 to 2013** | | All | Men | Women | | --- | --- | --- | --- | | Eleven-year cumulative incidence | 5.71% | 7.07% | 4.34% | | Standardised lifetime prevalence | 11.5% | 12.9% | 9.8% | The cumulative incidence was highest in the 60-to-69 age band at 9.08 percent, higher than in any other group. Age over 60, income level, diabetes, body mass index, hypertension and a history of cancer were all identified as contributing factors. **11.5%** — estimated standardised lifetime prevalence of urolithiasis in Korea — 12.9 percent in men, 9.8 percent in women _Source: Tae BS et al., Journal of Korean Medical Science, 2018_ ### The number that changes the follow-up Of the patients diagnosed over the study period, 21.3 percent had a recurrence within five years. That single figure is what separates a stone from an appendix. An appendicectomy ends a disease. A stone removal ends an episode of one, and in about a fifth of Korean patients the disease announces itself again inside five years. > **What a recurrence rate from claims data can and cannot count** > A recurrence here is a new diagnostic code, not a new stone confirmed by a radiologist against the earlier images. It cannot separate a genuinely new stone from a residual fragment that finally moved, and it cannot count stones that formed silently in patients who were never scanned again. The two errors run in opposite directions and neither is resolved by the data. 21.3 percent is the rate at which Korean stone patients came back into the system, which is a real and useful thing to know and is not the same quantity as the rate at which Korean patients form second stones. ### Where the two national studies disagree A second analysis, published in Investigative and Clinical Urology, used the same national sample cohort over the same 2002 to 2013 window and reached a different conclusion about the trend. It enrolled 1,111,828 subjects, of whom 36,857 were diagnosed with urolithiasis, and found a total incidence rate of 3.27 per 1,000 person-years that did not climb: the lowest annual count fell in 2013 and the highest in 2005. Prevalence, meanwhile, rose steadily from 3,172 in 2002 to 5,758 in 2013. The first study reported the annual incidence increasing every year. The second reported it stable. They are not describing different countries, and the gap is less a contradiction than a definition. Prevalence counts everybody living with the diagnosis, and a disease whose recurrence rate is one in five accumulates people even when the rate of new cases holds flat. A stable incidence beneath a rising prevalence is what a chronic, recurring condition looks like in claims data. - Incidence by diagnostic code was highest for ureteric stone alone at 2.49 per 1,000 person-years and lowest for kidney and ureteric stone together at 0.17. - The male-to-female ratio was 1.57 to 1, and peak incidence fell at ages 45 to 49. - Jeollanam-do had the highest provincial incidence at 3.70 per 1,000 person-years; Jeju had the lowest at 2.84. - Among men, Daegu had the highest incidence at 4.56 per 1,000 person-years; among women, Jeollanam-do at 3.20. The peak incidence age of 45 to 49 and the peak cumulative incidence band of 60 to 69 are not in conflict either. One is the age at which Koreans are most likely to form a first stone; the other is the band that has had the most years in which to have formed one. ### What is supposed to happen next The European Association of Urology's 2024 guideline update on metabolic evaluation and recurrence prevention sets out the follow-up that a one-in-five recurrence rate implies. Every patient with urolithiasis should have an attempt made to analyse the stone. Every patient should have baseline metabolic screening. Patients with calcium stones at high risk of relapse should have extensive metabolic screening with two 24-hour urine collections and receive targeted therapy, and patients with uric acid, infection or cystine stones are classified as high-risk for relapse outright. None of that is surgery, and none of it happens in an operating theatre. It is the part of stone care a claims database cannot see: whether the patient who came back with a second stone had ever been given a reason to expect one. ### What these figures settle Both studies analyse insurance claims, and their strength is coverage of a nationally representative cohort rather than the patients of one hospital. Their limits run the same way in both: they count diagnostic codes rather than stones, they cannot say whether any particular scan was warranted, and they carry nothing about fluid intake, heat exposure at work, or urine chemistry. What they establish is the scale of the thing. Around one Korean in nine is diagnosed with a urinary stone at some point in life, one in five of those is back inside five years, and first stones peak at an age when most people are working. Those three facts together are an argument for treating the first stone as the start of a follow-up rather than the end of an emergency. ## Sources - Tae BS, Balpukov U, Cho SY, Jeong CW. Eleven-year cumulative incidence and estimated lifetime prevalence of urolithiasis in Korea: a National Health Insurance Service-National Sample Cohort based study. Journal of Korean Medical Science 2018;33(2):e13. doi:10.3346/jkms.2018.33.e13. PMID:29215822. https://doi.org/10.3346/jkms.2018.33.e13 - Jung JS, Han CH, Bae S. Study on the prevalence and incidence of urolithiasis in Korea over the last 10 years: an analysis of National Health Insurance Data. Investigative and Clinical Urology 2018;59(6):383-391. doi:10.4111/icu.2018.59.6.383. PMID:30402571. https://doi.org/10.4111/icu.2018.59.6.383 - Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, Davis N, Tzelves L, et al. Metabolic evaluation and recurrence prevention for urinary stone patients: an EAU guidelines update. European Urology 2024;86(4):343-363. doi:10.1016/j.eururo.2024.05.029. PMID:39069389. https://doi.org/10.1016/j.eururo.2024.05.029 - 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). "About one Korean in nine will form a urinary stone. One in five of them will form another within five years". Medical Insights Korea. https://medicalinsightskorea.com/news/korea-urolithiasis-lifetime-risk-and-recurrence Retrieved from https://medicalinsightskorea.com/news/korea-urolithiasis-lifetime-risk-and-recurrence