Clinical findings highlighting that physician experience and clinical judgment play a more important role than hospital size or equipment in urinary stone treatment have been presented at an international academic conference. At the 45th International Congress of the Société Internationale d'Urologie (SIU 2025) held in Edinburgh, United Kingdom, data analyzing 165 urinary stone surgeries performed at Goldman Urology Clinic Jamsil Branch drew considerable attention.
Urinary stones are generally categorized by difficulty depending on their size and location. In most cases, stones larger than 10 mm or those located in the upper ureter or within the kidney are classified as 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 diversity, all procedures were completed successfully, and no major complications occurred. Some patients experienced mild reactions such as temporary pain or minimal bleeding, but these effects were minor and resolved within a short period with appropriate management.
These findings clearly indicate that the size or location of a stone does not necessarily determine surgical risk. In urinary stone treatment, a more important factor than the stone itself is how the surgeon approaches it and what strategy is used to fragment and remove it. Even with stones of similar size and location, the level of difficulty and procedural safety can vary significantly depending on the surgical approach and treatment strategy.
Another common misunderstanding among patients undergoing complex stone surgery concerns anesthesia. Many believe that when stones are large or located deep within the kidney, general anesthesia is always required. In clinical practice, however, this is not necessarily 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, enable faster recovery, and can shorten hospital stays. For elderly patients or those with underlying cardiovascular or respiratory diseases, avoiding general anesthesia can be particularly meaningful from a safety perspective.
Therefore, even when stones are large, general anesthesia is not always a mandatory condition. Instead, the most appropriate anesthetic approach should be selected after 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 level of expertise is a critical factor. Although the procedure may appear standardized externally, the actual surgical process involves a continuous series of decisions. These include selecting the appropriate access sheath, adjusting laser energy depending on the hardness and structure of the stone, deciding whether to pulverize the stone into fine particles (dusting) or divide it into removable fragments, maintaining stable intrarenal pressure during surgery, and securing clear visualization. Surgeons must also respond appropriately to unexpected situations such as bleeding, reduced visibility, or stone migration during the procedure. Each of these decisions can significantly affect both surgical safety and outcomes.
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 simply by the size of a hospital or the sophistication of its equipment. Rather, treatment success depends largely on how much clinical experience a 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.