Clinical data demonstrating that the medical team's approach strategy and clinical experience, rather than stone size or location, determine treatment outcomes in complex kidney and urinary tract stone treatment, has been unveiled on the international academic stage. Recently, at the 45th International Urological Society (SIU 2025), held in Edinburgh, UK, an analysis of the clinical results of 165 cases of urinary tract stone surgery performed at Goldman Urology Jamsil Branch was presented, garnering significant attention.
Urinary tract stones are generally known to be categorized by difficulty based on their size and location. Typically, stones exceeding 10mm, or those situated in the upper ureter or within the kidney, are classified as high-difficulty stones. Due to this classification, patients often vaguely assume that larger or more deeply located stones necessitate more perilous surgical procedures.
However, the 165 surgical cases analyzed in this study encompassed a diverse range of scenarios, from small 3mm stones to relatively large ones measuring up to 25mm. Furthermore, a significant number of stones located not only in the lower ureter but also in the upper ureter and within the kidney were included. Despite this variety, all surgical procedures were successfully completed. Moreover, not a single major complication was observed. While some minor reactions such as temporary pain or microscopic bleeding were noted, all were at a level that could be stably managed within a short period.
These results clearly demonstrate that the size and location of the stone itself do not inherently signify risk. In fact, a more crucial factor in stone treatment hinges not on which stone is to be removed, but rather on how the stone is approached, and with what strategy it is fragmented and extracted. It is explained that even for an identical stone, the difficulty and safety of the procedure can vary significantly depending on the access method and surgical strategy employed.
Another aspect that patients frequently misunderstand regarding complex stone surgery is the method of anesthesia. Many patients believe that if a stone is large or deeply embedded within the kidney, general anesthesia is absolutely mandatory. However, this is not necessarily true in actual clinical practice. The majority of URS (Ureteroscopy) and RIRS (Retrograde Intrarenal Surgery) procedures performed by Goldman Urology, as presented at this conference, were conducted under spinal or local anesthesia. This approach offers the benefits of reducing the cardiopulmonary burden associated with general anesthesia, leading to faster recovery, and shortening the duration of hospitalization. Particularly for elderly patients or those with underlying conditions such as cardiovascular or respiratory diseases, the ability to avoid general anesthesia holds significant importance from a safety perspective.
Therefore, a large stone size does not automatically necessitate general anesthesia. Instead, it is crucial to comprehensively consider factors such as the stone's location, the patient's overall systemic condition, and the potential for pain control, to select the most appropriate anesthesia method.
In the context of endoscopy-based urinary tract stone surgery, the proficiency of the medical team is paramount. While it may outwardly appear to be a standardized procedure, the actual surgical process involves a continuous series of numerous critical choices. Medical judgment is essential at every stage, including deciding which access sheath to utilize, how to adjust laser energy based on the stone's hardness and morphology, whether to employ a dusting method for fine fragmentation or a technique of dividing the stone into specific sizes for removal, and how to stably maintain intrarenal pressure and secure the surgical field during the operation. Furthermore, should unforeseen variables such as unexpected bleeding, compromised visibility, or stone migration arise, the safety and ultimate outcome of the surgery can significantly differ based on how these challenges are addressed.
Dr. Na Jun-chae of Goldman Urology Jamsil Branch stated, "Urinary tract stones not only cause excruciating pain but, if left untreated for an extended period, can lead to serious complications such as ureteral obstruction, infection, and deterioration of kidney function." He further emphasized, "Urinary tract stone surgery is not a field that can be assessed merely by the size of the hospital or the sophistication of its equipment. Instead, the success or failure of treatment is determined by the extent of clinical experience accumulated by individual medical professionals, how many diverse stone types and situations they have personally managed, and how robust their accumulated judgment skills are through that process."