돌 치료의 진화: 전쟁터에서 고도의 의료 기술까지

마지막 업데이트: 8월 17, 2026

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현대 비뇨기과 분야에서 가장 혁신적인 기술 중 하나인 체외 충격파 쇄석술(ESWL)의 역사와 과학을 함께 살펴보는 여정에 여러분을 초대합니다. 신장 결석 치료를 전문으로 하는 전문의로서, 전쟁 중의 한 관찰이 어떻게 오늘날 우리가 시행하는 가장 정교한 비침습적 시술 중 하나로 발전하게 되었는지 여러분께 소개해 드리고자 합니다.

이 글은 2018년 11월 17일 ‘로열 프놈펜 비뇨기과 세미나’에서 제가 발표한 공식 발표 내용을 바탕으로 작성되었습니다. 그 세미나는 제 경력에 있어 여전히 의미 있는 이정표로 남아 있습니다. 바로 그 자리에서 우리는 의학 혁신의 역사적 뿌리를, 현재 제가 방콕 병원 본원과 사미티베지 스리라차 병원에서 환자들에게 제공하고 있는 최첨단 치료법과 연결 지을 수 있었습니다.

Before the History: When a Stone Becomes an Emergency

This article is about technology, and technology is the least urgent part of stone disease. Before reading on, it is worth knowing which stone situations cannot wait, because the answer to them is not a lithotripter appointment:

• Fever or shaking chills with flank pain. This suggests an infected, obstructed kidney — the true emergency of stone disease. It needs urgent drainage of the kidney, not antibiotics alone, and it can become life-threatening within hours.
• Passing little or no urine, or severe pain in a man with a single functioning kidney or a transplanted kidney.
• Pain with persistent vomiting that prevents you keeping fluids down.
• Suspected stone in pregnancy, which needs assessment by a team rather than a standard pathway.

In Thailand the emergency number is 1669. Everything below assumes you are not in one of these situations.

충격파란 정확히 무엇인가요?

To understand how we break kidney stones without a single incision, we must first understand the physics of the shockwave. In scientific terms, a shockwave is a 매질을 통해 이동하는 좁은 영역에서의 급격한 압력 변화 공기나 물과 같은 매질을 통해 전달됩니다. 이러한 파동은 일반적으로 폭발이나 음속보다 빠르게 움직이는 물체에 의해 발생합니다.

In urology, we harness this energy and aim it with precision. Think of it like a focused beam of sound energy: much like a magnifying glass focuses sunlight onto a single point to create heat, an ESWL machine focuses shockwaves onto a kidney stone to create mechanical stress, eventually shattering the stone into dust or small fragments that can be passed naturally in the urine.

놀라운 역사: 전장에서 병원으로

ESWL의 역사는 한 분야의 발견이 다른 분야를 완전히 바꿔놓는, 이른바 ‘이중용도 기술’의 전형적인 사례입니다.

• 제2차 세계 대전과의 연관성 제2차 세계 대전 중, 수중 폭뢰 폭발 근처에 있던 선원들과 군인들이 외부 상처가 전혀 없었음에도 심각한 폐 손상을 입었다는 것이 관찰되었습니다. 이는 충격파가 물과 인체를 통해 내부 구조에 영향을 미칠 수 있다는 것을 증명했습니다.
• 『The Breakthrough』(1980): 수십 년에 걸친 고에너지 물리학 연구가 마침내 의학계의 획기적인 성과를 낳았습니다. 1980년 2월 7일, 독일에서 1세대 체외 충격파 쇄석기를 이용한 최초의 인간 치료가 시행되었습니다. 이 단 한 번의 사건은 비뇨기과를 영원히 바꾸어 놓았으며, 과거 대수술이었던 시술을 비침습적 시술로 전환시켰습니다.

The Four Generations of ESWL

1980년대 이후 기술은 빠르게 발전해 왔습니다. 각 세대의 기계는 치료를 더 효과적으로 만들기 위해 노력했습니다. 더 안전하고, 더 편안하며, 더 정확하게. One caution before the list, because it is easy to read a story of generations as a story of steadily better results: what improved most across the generations was comfort, size, cost and targeting. Stone clearance itself has not improved in the same straight line, and the characteristics of your stone matter more than the age of the machine.

1. The First Generation: The Water Bath Era

초기 기계는 거대했습니다. 작동을 위해 환자는 충격파가 생성기에서 몸으로 전달될 수 있도록 큰 욕조의 물에 잠겨야 했습니다. 단점은 상당했습니다. 이 기계는 엄청나게 비싸고 거대했으며, 초점 영역(에너지가 도달하는 부위)이 넓어 정밀성이 떨어졌고, 환자는 전신 마취가 필요했으며, 일반적으로 입원이 필요했습니다.

2. The Second Generation: The Dry Patient

Engineers replaced the giant water tub with a small water-filled cushion or bellows pressed against the patient’s skin. The patient stayed dry, and the focal zone became tighter and more accurate. Some treatments could be done under local anesthesia — but the machines remained large and still required significant radiation exposure for stone targeting.

3. 3세대: 컴팩트한 효율

These machines became much smaller and more mobile. However, they still relied heavily on X-ray (fluoroscopy) for targeting, meaning patients were exposed to radiation. Furthermore, the patient’s breathing caused the kidney stone to move up and down with each respiration, making it difficult to maintain a perfect hit rate on the stone. This is the generation in use at Bangkok Hospital Headquarters today, and it remains a thoroughly established treatment — the large majority of the world’s published ESWL evidence was generated on machines of this type.

4. The Fourth Generation

This generation represents a real advance in targeting and patient comfort. I introduced Cambodia’s first 4th-generation lithotripter at Royal Phnom Penh Hospital in 2018, after training on the system at Chang Gung Memorial Hospital in Taiwan. At Bangkok Hospital Headquarters, ESWL is currently performed using a 3rd-generation lithotripter. The improvements of the 4th generation are these:

• Automated stone localization: the system assists in finding and holding the target.
• Radiation-free targeting: ultrasound rather than X-ray can be used to locate the stone, so a session can be completed without radiation exposure. In practice X-ray is still used in some cases, for example where the stone is not clearly seen on ultrasound.
• Respiratory tracking: the ultrasound system follows the stone as it moves with the patient’s breath, so more of the shockwaves land on the target rather than on surrounding tissue.
• Less need for anesthesia: many patients tolerate treatment with little or no analgesia and return home the same day. This is about comfort during the session; it does not by itself mean more stones are cleared.

무엇이 성공을 결정하는가?

Whichever generation of lithotripter is used, whether a stone breaks depends far more on the stone than on the machine:

인수분해	설명
Stone hardness	Not all stones are alike. CT scanning measures stone density in Hounsfield Units. Dense stones — calcium oxalate monohydrate and cystine in particular — resist shockwaves and may not fragment at all, whichever machine is used.
Stone location	Stones in the kidney or upper ureter generally do better than those in the lower pole, where fragments must travel uphill to leave the kidney and often simply stay there.
Stone size	Stones under 10 mm do best. Above 10 mm, a single session clears fewer stones and a second treatment is more often needed.
Body habitus	The distance from skin to stone matters. Where that distance is large, the shockwave arrives with less energy and success falls — which is why ESWL is not the right choice for every patient.

A note on the success figures quoted for ESWL, including on this site in the past. Published rates for stones under 10 mm are often given as roughly 85–90%, but those numbers move a great deal depending on what is being counted. Being stone-free on a CT scan is a far stricter test than having no fragment larger than 4 mm, and studies use both. Density, location and skin-to-stone distance shift the figure further. The honest way to use a published rate is as a starting point for a conversation about your own stone, not as a promise.

What ESWL Asks of You: Risks and Aftermath

Non-invasive does not mean without consequence, and a history of the technology would be incomplete without saying what the treatment actually involves for a patient. Expected effects in the days afterwards include blood in the urine, bruising or tenderness of the skin over the treated side, and colicky pain as fragments make their way down the ureter — that pain can be worse than the original stone, and it is normal rather than a sign of failure.

The complications worth knowing about are:

• Steinstrasse — literally a street of stones: fragments lining up and blocking the ureter. Increasing pain, or any pain accompanied by fever, after treatment needs assessment rather than waiting.
• 전염병, including sepsis from bacteria released as the stone breaks up. This is why a urine infection is treated before treatment, never during it.
• Bleeding around the kidney (perirenal haematoma) — uncommon, and more likely with uncontrolled blood pressure or a bleeding tendency.
• Incomplete fragmentation, needing a second session or a change of plan to ureteroscopy.

ESWL is not suitable for everyone. It is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation that has not been managed beforehand, where there is an obstruction below the stone that would prevent fragments passing, and where an aortic or renal artery aneurysm sits in the shockwave path. Whether you can safely pause a blood thinner is a decision for the doctor who prescribed it, together with your urologist — never a decision to make on your own.

What happens after treatment is set out in detail in my patient instructions for 3rd-generation ESWL, which is the machine used at Bangkok Hospital Headquarters. And because breaking a stone is not the same as solving the problem, the more important half of stone care is preventing the next one — and for one stone type in particular, medication can dissolve the stone rather than break it.

최종 생각

The evolution of ESWL — from a wartime observation to a 4th-generation tracking system — is a testament to the power of medical innovation. My presentation in 2018 at Royal Phnom Penh Hospital was, in many ways, a celebration of this progress. But the lesson I took from it, and still hold, is that the machine is the least interesting variable. Whichever generation of lithotripter is used, ESWL remains a non-invasive, same-day treatment that allows most patients to return to normal life quickly — and careful patient selection matters far more than the age of the equipment. At Bangkok Hospital Headquarters, ESWL is performed using a 3rd-generation lithotripter, with candidates selected on the basis of stone size, location, density and body habitus. For stones that ESWL cannot handle well, flexible ureteroscopy with holmium laser (RIRS) is generally the better answer.

If you are dealing with kidney stones and would like to discuss which treatment is right for you, Dr. Soarawee Weerasopone provides specialist kidney stone care at 방콕 병원 본사 and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly — Bangkok Hospital at bhquro@bdms.co.th, or Samitivej Sriracha on 088-022-1445.

ESWL 관련 자주 묻는 질문

ESWL은 체외 충격파 쇄석술의 약자입니다. 신장 결석을 부수는 데 사용되는 비침습적 치료법입니다. ESWL은 특정 주파수의 충격파를 신장 결석에 집중시켜 결석을 작고 통증 없이 배출될 수 있는 작은 조각으로 분해합니다. 이 충격파는 몸 밖에서 생성되어 피부를 통해 신장으로 전달됩니다.

체외 충격파 쇄석술(Extracorporeal Shockwave Lithotripsy, ESWL)은 신장 결석을 작은 조각으로 부수기 위해 체외에서 생성된 집중된 충격파를 사용합니다. 충격파는 피부와 조직을 통과하여 결석에 에너지를 집중시켜 요로를 통해 자연적으로 배출될 수 있을 만큼 작은 조각으로 부숩니다.

What are the risks of ESWL, and when should I seek help after treatment?

Blood in the urine, skin tenderness over the treated side and colicky pain as fragments pass are expected in the days afterwards. The complications to know about are steinstrasse (fragments blocking the ureter), infection including sepsis, bleeding around the kidney, and incomplete fragmentation needing a further session. Seek care urgently for fever or shaking chills, pain that is escalating rather than settling, persistent vomiting, or passing little or no urine. In Thailand the emergency number is 1669.

Who should not have ESWL?

ESWL is avoided in pregnancy, with an untreated urinary infection, with a bleeding disorder or anticoagulation not managed in advance, where an obstruction below the stone would stop fragments passing, and where an aortic or renal artery aneurysm lies in the shockwave path. Very dense stones and a large skin-to-stone distance also make ESWL a poor choice, and flexible ureteroscopy with holmium laser is often better in those situations. Never stop a blood thinner on your own — that decision belongs to the doctor who prescribed it.

ESWL은 통증이 있거나 마취가 필요한가요?

ESWL is generally well tolerated and is performed as a same-day procedure. How much pain relief is needed depends partly on the machine: with 4th-generation systems many patients need no anesthesia at all, while with 3rd-generation lithotripters — including the one used at Bangkok Hospital Headquarters — short-acting intravenous analgesia or light sedation is commonly given. In either case, patients normally return home the same day.

ESWL(체외충격파쇄석술)은 평균적으로 4mm에서 20mm 사이의 신장 결석 치료에 가장 효과적입니다.

Stones under 10 mm respond best. Published success rates for this group are often quoted around 85–90%, but the figure depends heavily on how success is defined — being completely stone-free on CT is a much stricter test than having no fragment above 4 mm — and on stone density, position and skin-to-stone distance. Stones above 10 mm may still respond but more often need a second session or a different approach.

현대 ESWL은 여전히 X-레이 방사선을 사용합니까?

It depends on the generation of the machine. Fourth-generation systems can localize the stone with ultrasound and complete a session without X-ray, although fluoroscopy is still used in some cases where the stone is not clearly visible. Third-generation lithotripters — including the one used at Bangkok Hospital Headquarters — rely on X-ray fluoroscopy for targeting, although exposure is brief and kept as low as reasonably achievable, and the dose is comparable to routine diagnostic imaging.

Is a newer machine always better?

Not in the way the word generation suggests. What improved most across the four generations was patient comfort, machine size and cost, and the accuracy of targeting. Stone clearance did not improve along the same straight line, and it depends far more on the density, size, position and depth of your particular stone. A well-selected patient on a 3rd-generation machine will do better than a poorly selected one on a 4th-generation machine.

고지 사항: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No diagnosis, advice or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.