Clinical data demonstrating that complex urinary stone surgery is not necessarily a high-risk treatment has recently been presented. At the 45th International Congress of the Société Internationale d'Urologie (SIU 2025) held in Edinburgh, United Kingdom, the treatment outcomes of 165 urinary stone surgeries performed at Goldman Urology Clinic Jamsil Branch were introduced.
Urinary stones are generally categorized by difficulty depending on their size and location. Stones larger than 10 mm, or those located in the upper ureter or inside the kidney, are typically considered complex stones. Because of this classification, many patients assume that larger or deeper stones inevitably require more dangerous surgical procedures.
However, the 165 surgical cases analyzed in this study included a wide range of stones, from small stones measuring about 3 mm to relatively large stones up to 25 mm. The cases also involved stones located not only in the lower ureter but also in the upper ureter and within the kidney. Despite this variety, all surgeries were completed successfully, and no major complications occurred. Some patients experienced minor reactions such as temporary pain or minimal bleeding, but these were mild and resolved with short-term management.
These findings clearly show that the size or location of a stone does not necessarily determine the risk of treatment. In fact, a more important factor in stone treatment is not simply which stone is removed, but how the stone is approached and what strategy is used for fragmentation and removal. Even with similar stones, the level of difficulty and safety can vary significantly depending on the surgical approach and treatment strategy.
Another common misconception among patients regarding complex stone surgery involves anesthesia. Many people believe that when stones are large or located deep within the kidney, general anesthesia is always required. In clinical practice, however, this is not necessarily the case.
Most of the URS (ureteroscopy) and RIRS (retrograde intrarenal surgery) procedures presented at the conference were performed under spinal anesthesia or local anesthesia. These approaches reduce cardiopulmonary stress associated with general anesthesia, allow faster recovery, and may shorten hospital stays. For elderly patients or those with underlying conditions such as cardiovascular or respiratory diseases, avoiding general anesthesia can be particularly meaningful from a safety perspective.
Therefore, even when stones are large, general anesthesia is not always mandatory. Instead, the most appropriate anesthetic method should be selected after considering factors such as the location of the stone, the patient’s overall health condition, and the ability to control pain during the procedure.
In endoscopic urinary stone surgery, the surgeon’s level of experience plays a critical role. Although the procedures may appear standardized externally, the actual surgical process involves numerous real-time decisions. These include selecting the appropriate access sheath, adjusting laser energy according to the stone’s hardness and shape, determining whether to pulverize the stone into fine fragments (dusting) or divide it into removable pieces, and maintaining stable intrarenal pressure while securing a clear surgical field. The surgeon must also respond appropriately to unexpected variables such as bleeding, reduced visibility, or stone migration during the operation. These decisions can significantly influence the safety and outcome of the procedure.
Dr. Na Jun-chae of Goldman Urology Clinic Jamsil Branch explained that urinary stones not only cause severe pain but can also lead to ureteral obstruction, infection, and decreased kidney function if left untreated for a long period. He emphasized that the success of urinary stone surgery cannot be judged simply by the size of the hospital or the sophistication of the equipment. Rather, it depends on how much clinical experience the physician has accumulated, how many different types of stones and clinical situations they have managed directly, and how strong their clinical judgment has become through that experience.