Clinical results demonstrating that the experience and judgment of the medical team are more crucial than hospital size or equipment in the treatment of urinary tract stones were presented at an international academic conference. Indeed, data analyzing 165 cases of urinary tract stone surgeries performed at Goldman Urology Jamsil branch was unveiled at the 45th International Urological Society (SIU 2025), held in Edinburgh, UK, drawing significant attention.
Urinary tract stones are generally known to be categorized by difficulty based on their size and location. Typically, stones exceeding 10mm, or those situated in the upper ureter or within the kidney, are classified as high-difficulty stones. Due to this classification, patients frequently harbor the vague notion that larger or more deeply located stones necessitate more perilous surgical procedures.
However, the 165 surgical cases analyzed in this study encompassed a diverse range of scenarios, from small 3mm stones to comparatively large ones measuring up to 25mm. Moreover, a significant number of stones were included that were located not only in the lower ureter but also in the upper ureter and within the kidney. Despite these varying complexities, all surgical procedures were successfully completed. Furthermore, not a single major complication was reported. While some minor reactions, such as temporary pain or micro-bleeding, were observed, all were at a level that could be stably managed within a short timeframe.
These findings unequivocally demonstrate that the size and location of a stone do not inherently equate to risk. In reality, a more critical determinant in stone treatment is not simply which stone needs to be removed, but rather how the stone is approached, and what strategy is employed for its fragmentation and extraction. This elucidates that even for an identical stone, the level of difficulty and overall safety can differ substantially based on the chosen access method, surgical strategy, and other pertinent factors.
Another common misconception among patients regarding high-difficulty stone surgery pertains to the method of anesthesia. Many patients presume that general anesthesia is invariably required if the stone is large or deeply embedded within the kidney. However, this is not necessarily true in actual clinical practice. The majority of URS (Ureteroscopy) and RIRS (Retrograde Intrarenal Surgery) procedures performed by Goldman Urology, as presented at this conference, were carried out under spinal or local anesthesia. This approach offers several advantages, including a reduction in the cardiopulmonary burden typically associated with general anesthesia, faster patient recovery, and a shortened hospital stay. For elderly patients or those with underlying health conditions such as cardiovascular or respiratory diseases, the ability to avoid general anesthesia holds significant implications for patient safety.
Therefore, a large stone size does not automatically render general anesthesia an indispensable requirement. Instead, it is paramount to holistically evaluate various factors, including the stone's precise location, the patient's overall systemic health, and the potential for effective pain management, in order to determine and select the most suitable anesthesia method.
For endoscopy-based urinary tract stone surgery, the proficiency and skill of the medical team are of paramount importance. While the procedure may outwardly appear to be a standardized surgical technique, the actual surgical process involves a continuous succession of numerous critical decisions. Medical judgment is indispensable at every stage, including determining which access sheath to utilize, how to precisely calibrate the laser energy based on the stone's hardness and morphology, whether to employ a "dusting" method to finely pulverize the stone or a technique of fragmenting it into specific sizes for subsequent removal, and how to consistently maintain stable intrarenal pressure while ensuring an optimal surgical field throughout the operation. Moreover, the safety and ultimate outcome of the surgery can be profoundly influenced by the medical team's ability to effectively respond to unforeseen variables, such as unexpected bleeding, compromised visibility, or stone migration, should they arise.
Dr. Na Jun-chae of Goldman Urology Jamsil branch stated, "Urinary tract stones are a condition that not only causes excruciating pain but, if left untreated for an extended period, can progress to ureteral obstruction, infection, and a decline in kidney function." He further emphasized, "Urinary tract stone surgery is not a domain that can be assessed merely by the hospital's size or the ostentatiousness of its equipment. Rather, the ultimate success or failure of the treatment is critically determined by the depth of clinical experience individual medical professionals have amassed, the breadth of diverse stone types and complex situations they have personally managed, and the robustness of the judgment capabilities cultivated through those extensive experiences."