Clinical analysis results, revealing that the difficulty and success of urolithiasis surgery are determined more by the surgical access plan and strategy than by the size of the stone itself, were unveiled at an international academic conference.
Recently, at the 45th International Urological Society (SIU 2025) held in Edinburgh, UK, the medical team from Goldman Urology Jamsil Branch presented the comprehensive analysis results of 165 cases of urolithiasis surgery. Urolithiasis cases are generally categorized by difficulty based on stone size and location, with stones exceeding 10mm or located in the upper ureter or within the kidney being classified as high-difficulty cases. Consequently, there is a widespread perception among patients that larger or deeper stones necessitate more dangerous surgeries.
However, this analysis included a diverse range of cases, from small stones measuring 3mm to relatively large stones reaching 25mm. The stone locations were also widely distributed, not only in the lower ureter but also in the upper ureter and within the kidney. Despite this variety, all surgeries were successfully completed, and no major complications occurred. Although temporary pain or minor bleeding was observed in some cases, all were manageable within a short period.
These results suggest that the size or location of the stone itself does not necessarily indicate the surgical risk. In actual urolithiasis treatment, it is explained that how one approaches the stone and what strategy is employed for its fragmentation and removal are more critical factors than simply which stone is being removed. Even for the same stone, the difficulty and safety can vary significantly depending on the access method and surgical strategy.
The perception regarding anesthesia methods is also one of the common misconceptions among patients. Many believe that general anesthesia is always necessary if the stone is large or deeply located within the kidney, but this is not necessarily true in actual clinical practice. A significant number of cases presented at this conference involved ureteroscopy (URS) or retrograde intrarenal surgery (RIRS) performed under spinal or local anesthesia. This helps reduce cardiopulmonary burden associated with general anesthesia, accelerate recovery, and shorten hospital stays. This is particularly significant in terms of safety for elderly patients or those with underlying conditions such as cardiovascular or respiratory diseases.
For endoscopy-based urolithiasis surgery, the proficiency of the medical team acts as a crucial variable. While it may appear to be a standardized procedure, the actual surgical process is a continuous series of numerous judgments. At every stage, from selecting the access sheath, setting the laser parameters according to stone characteristics, determining the fragmentation method, managing intrarenal pressure and securing the visual field, to responding to unexpected bleeding or stone migration, the experience and judgment of the medical staff directly influence the surgical outcome.
Dr. Na Jun-chae of Goldman Urology Jamsil Branch stated, "Urolithiasis is a disease that not only causes severe pain but can also lead to ureteral obstruction, infection, and kidney function deterioration if left untreated for a long time." He added, "The surgical outcome can vary depending on how many diverse stone types and situations the medical team has directly experienced, and how robust their accumulated judgment skills are through that process, rather than merely the hospital's size or equipment."