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 academic conference. Indeed, data analyzing 165 cases of urolithiasis surgery performed at Goldman Urology's Jamsil branch was unveiled at the 45th International Urological Society (SIU 2025), held in Edinburgh, UK, drawing significant attention.
Urolithiasis is known to be categorized by difficulty based on its size and location. Generally, 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 often vaguely assume 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 situations, from small stones measuring 3mm to relatively large ones reaching 25mm. Furthermore, a significant number of stones located not only in the lower ureter but also in the upper ureter and within the kidney were included. Despite these varied complexities, all surgical cases proceeded successfully. Moreover, not a single major complication occurred. 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 period.
These results clearly demonstrate that the size and location of a stone do not inherently signify 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 an identical stone, the difficulty and safety of the procedure can vary significantly depending on the approach method and surgical strategy.
Another aspect that patients frequently misunderstand regarding high-difficulty stone surgery is the method of anesthesia. Many patients believe that if a stone is large or deeply embedded within the kidney, general anesthesia is absolutely essential. However, this is not necessarily true in actual clinical practice. Most URS (Ureteroscopy) and RIRS (Retrograde Intrarenal Surgery) procedures performed at Goldman Urology, as presented at this conference, were conducted under spinal or local anesthesia. This approach offers several advantages: it can reduce the cardiopulmonary burden associated with general anesthesia, facilitates faster recovery, and can shorten the length of hospital stay. This is particularly significant in terms of safety for elderly patients or those with underlying conditions such as cardiovascular or respiratory diseases, as it allows them to avoid general anesthesia.
Thus, a large stone size does not automatically make general anesthesia a mandatory requirement. Instead, it is crucial to comprehensively consider factors such as the stone's location, the patient's overall systemic condition, and the potential for pain control, to select the most appropriate anesthesia method.
In the case of endoscopy-based urolithiasis surgery, the proficiency of the medical team is paramount. While it may outwardly appear to be a standardized procedure, the actual surgical process involves a continuous series of numerous critical choices. Medical judgment is essential at every stage, including deciding which access sheath to utilize, how to adjust laser energy settings based on the stone's hardness and morphology, whether to opt for a fragmentation (dusting) method to finely pulverize the stone or a method of dividing it into specific sizes for removal, and how to stably maintain intrarenal pressure and secure the visual field during the operation. Furthermore, the safety and outcome of the surgery can significantly differ depending on how the medical team responds to unforeseen variables such as unexpected bleeding, impaired visibility, or stone migration.
Dr. Na Jun-chae of Goldman Urology's Jamsil branch stated, "Urolithiasis is a condition that not only causes excruciating pain but, if left untreated for an extended period, can lead to ureteral obstruction, infection, and deterioration of kidney function." He further emphasized, "Urolithiasis surgery is not an area that can be assessed solely by the hospital's scale or the sophistication of its equipment. Instead, the success or failure of the treatment hinges on how much clinical experience individual medical professionals have amassed, how many diverse stone types and situations they have directly managed, and how robust their accumulated judgment skills are through that extensive process."