Clinical data suggesting that treatment outcomes in complex kidney and urinary stone surgery depend more on the physician’s strategy and clinical experience than on the size or location of the stone have been presented on an international academic stage. At the 45th International Congress of the Société Internationale d'Urologie (SIU 2025) held in Edinburgh, United Kingdom, the clinical outcomes of 165 urinary stone surgeries performed at Goldman Urology Clinic Jamsil Branch were presented and drew considerable attention.
Urinary stones are commonly classified by difficulty based on their size and location. In general, stones larger than 10 mm or those located in the upper ureter or within the kidney are 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 inside 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 results demonstrate that the size or location of a stone alone does not necessarily determine the risk of treatment. In fact, a more important factor in stone management 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 misunderstanding among patients undergoing complex stone surgery relates to anesthesia. Many believe that if a stone is large or located deep within the kidney, general anesthesia is unavoidable. In actual clinical practice, however, this is not always 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 at Goldman Urology Clinic. These methods reduce the cardiopulmonary burden associated with general anesthesia, allow faster recovery, and can shorten hospital stays. For elderly patients or those with underlying conditions such as cardiovascular or respiratory diseases, avoiding general anesthesia can provide significant safety advantages.
Therefore, even when stones are large, general anesthesia is not necessarily a mandatory requirement. Instead, the most appropriate anesthetic approach should be determined by comprehensively considering the stone’s location, the patient’s overall health condition, and the feasibility of pain control during the procedure.
In endoscopic urinary stone surgery, the surgeon’s experience plays a critical role. Although the procedure may appear standardized on the surface, the actual surgical process involves a continuous series of clinical decisions. Surgeons must determine which access sheath to use, how to adjust laser energy based on the stone’s hardness and structure, whether to pulverize the stone into fine particles (dusting) or divide it into removable fragments, and how to maintain stable intrarenal pressure while securing clear visualization during surgery. They must also respond appropriately to unexpected variables such as bleeding, reduced visibility, or stone migration during the operation. These decisions can significantly influence both 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 deterioration of kidney function if left untreated for a prolonged period. He emphasized that urinary stone surgery should not be evaluated solely based on the size of the hospital or the sophistication of its equipment. Rather, treatment success depends on how much clinical experience the individual physician has accumulated, how many different types of stones and clinical scenarios they have personally managed, and how strong their clinical judgment has become through that experience.