Clinical results demonstrating that the experience and judgment of the medical team are more crucial than hospital size or equipment in the treatment of urolithiasis were presented at an international conference. Specifically, data analyzing 165 cases of urolithiasis surgery performed at Goldman Urology Jamsil Branch was unveiled at the 45th International Urological Society (SIU 2025) held in Edinburgh, UK, attracting significant attention.
Urolithiasis is known to be categorized by difficulty based on the size and location of the stones. Generally, stones exceeding 10mm, or those located in the upper ureter or inside the kidney, are classified as high-difficulty stones. Due to this classification, patients often vaguely assume that larger or more deeply located stones necessitate riskier surgeries.
However, the 165 surgical cases analyzed in this study included a diverse range of cases, from small stones measuring 3mm to relatively large stones reaching 25mm. Furthermore, numerous stones located not only in the lower ureter but also in the upper ureter and inside the kidney were included. Despite this variety, all surgical cases were successfully performed. Moreover, not a single major complication occurred. While some minor reactions such as temporary pain or microscopic bleeding were observed, 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 necessarily equate to risk. In fact, a more crucial factor in stone treatment is not merely which stone is to be removed, but rather how the stone is approached, and what strategy is employed for its fragmentation and removal. It is explained that even for the same stone, the difficulty and safety can vary significantly depending on the approach method and surgical strategy.
Another common misconception among patients regarding high-difficulty stone surgery concerns the anesthesia method. Many patients believe that general anesthesia is absolutely necessary if the stone is large or deeply located within the kidney. However, this is not always the case in actual clinical practice. Most 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 offers advantages such as reducing cardiopulmonary burden associated with general anesthesia, faster recovery, and shorter hospital stays. Particularly for elderly patients or those with underlying conditions like cardiovascular diseases or respiratory illnesses, avoiding general anesthesia is significantly meaningful from a safety perspective.
Thus, a large stone size does not necessarily make general anesthesia a mandatory condition. Instead, it is crucial to comprehensively consider factors such as the stone's location, the patient's overall systemic condition, and the feasibility of pain control to select the most appropriate anesthesia method.
In the case of endoscopy-based urolithiasis surgery, the proficiency of the medical team is extremely important. While it may outwardly appear as a standardized procedure, the actual surgical process involves a continuous series of choices. Medical judgment is essential in every step, including what type of access sheath to use, how to set the laser energy based on the stone's hardness and morphology, whether to opt for a dusting method to finely fragment the stone or a method of dividing it into certain sizes for removal, and how to stably maintain intrarenal pressure and secure the surgical field during the operation. Furthermore, the safety and outcome of the surgery can vary significantly depending on how unexpected variables such as bleeding, impaired visibility, or stone migration are managed.
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, "Urolithiasis surgery is not an area that can be evaluated solely by the size of the hospital or the sophistication of its equipment. Instead, the success or failure of treatment is determined by how much clinical experience individual medical professionals have accumulated, how many diverse stone types and situations they have directly managed, and how robust their accumulated judgment skills are through that process."