A total of 165 cases of ureteroscopic surgery (URS) and retrograde intrarenal surgery (RIRS) were presented at the 45th Annual Meeting of the Société Internationale d’Urologie (SIU 2025), held in Edinburgh, UK, in late October. This presentation analyzed real-world clinical data from our institution, where these procedures are routinely performed, and received significant interest from international clinicians.
Based on these clinical results, it is important to clarify a common misconception among patients: that large or deeply located stones are inherently more dangerous to treat. In reality, the outcome of stone treatment depends less on size or location and more on how the stone is approached and managed during surgery.
Not all complex stones are high-risk. The 165 surgical cases included stones ranging from 3 mm to 25 mm in size, located in various regions such as the lower ureter, upper ureter, and kidney. While larger stones and higher locations are generally considered more technically challenging, all procedures were completed successfully without any major complications. Minor symptoms such as mild pain or slight bleeding did occur in some patients, but these were transient and safely managed.
This demonstrates that the success and safety of stone surgery are not determined solely by stone size or location, but by the surgical strategy used for access, fragmentation, and removal.
Another common question from patients is whether general anesthesia is required for stone surgery. In most cases presented, URS and RIRS were performed under spinal or local anesthesia rather than general anesthesia. This approach reduces the burden of anesthesia, allows for faster recovery, shortens hospital stay, and is often safer for elderly patients or those with underlying medical conditions.
Importantly, large stone size alone does not mandate general anesthesia. The choice of anesthesia should be individualized based on stone location and the patient’s overall health status.
The outcome of endoscopic stone surgery ultimately depends on the surgeon’s judgment and experience. Although URS and RIRS may appear similar in technique, several critical intraoperative decisions influence the result. These include selecting the appropriate access sheath, adjusting laser settings based on stone composition and hardness, choosing the optimal fragmentation technique, maintaining stable intrarenal pressure, and effectively managing unexpected situations.
Even when the same equipment is used, outcomes can differ significantly depending on the surgeon’s expertise. This highlights that clinical experience and decision-making play a more important role than hospital size or equipment alone.
From the patient’s perspective, the most important goal is clear: achieving safe and rapid stone removal. Urinary stones can cause severe pain and, if left untreated, may lead to complications such as hydronephrosis or impaired kidney function.
Therefore, the key question is not simply whether a procedure is easier, but which treatment method can resolve the condition most effectively and safely.
With over 20 years of clinical experience and more than two million cumulative cases, our institution designs individualized treatment strategies and continuously evaluates multiple surgical options to ensure the safest and most effective outcomes. Ongoing research and academic activities remain essential to improving surgical safety, accelerating recovery, and enhancing patient satisfaction.