An analysis presented at an international academic conference has shown that the difficulty and success of urinary stone surgery are influenced more by surgical planning and strategy than by the size of the stone itself.
At the 45th International Congress of the Société Internationale d'Urologie (SIU 2025) held in Edinburgh, United Kingdom, medical staff from Goldman Urology Clinic Jamsil Branch presented the results of a comprehensive analysis of 165 urinary stone surgery cases. Urinary stones are generally classified by difficulty according to their size and location, and stones larger than 10 mm or those located in the upper ureter or inside the kidney are typically categorized as complex cases. Because of this classification, many patients believe that larger or deeper stones inevitably require more dangerous surgical procedures.
However, the analysis included a wide range of cases, from small stones measuring about 3 mm to relatively large stones up to 25 mm. The stone locations also varied widely, including the lower ureter, upper ureter, and inside the kidney. Despite this diversity, all procedures were completed successfully, and no major complications occurred. Some patients experienced temporary pain or minor bleeding, but these reactions were mild and manageable within a short period.
These findings suggest that the size or location of a stone alone does not necessarily determine surgical risk. In urinary stone treatment, the more important factor is not simply which stone is removed, but how the surgeon approaches the stone and what strategy is used to fragment and remove it. Even when stones are similar in size or location, the level of difficulty and safety can vary significantly depending on the surgical approach and operative strategy.
Another area frequently misunderstood by patients involves the type of anesthesia used. Many believe that when stones are large or located deep inside the kidney, general anesthesia is required. In actual clinical practice, however, this is not always necessary. In many of the cases presented at the conference, ureteroscopy (URS) or retrograde intrarenal surgery (RIRS) was performed under spinal anesthesia or local anesthesia. 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 cardiovascular or respiratory diseases, avoiding general anesthesia can be particularly beneficial from a safety perspective.
Endoscopic urinary stone surgery also requires a high level of surgical expertise. Although the procedure may appear standardized externally, the actual operation involves a continuous series of decisions. These include selecting the appropriate access sheath, adjusting laser settings based on the characteristics of the stone, determining the most suitable fragmentation technique, maintaining stable intrarenal pressure while securing clear visualization, and responding to unexpected variables such as bleeding or stone migration. At each stage, the surgeon’s experience and judgment directly influence the final 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 long period. He emphasized that surgical outcomes depend not simply on the size of the hospital or the sophistication of its equipment, but rather on how much clinical experience the physician has accumulated and how effectively that experience has developed their clinical judgment in managing a wide range of stone types and surgical situations.