Summer is a high incidence period for urinary stones, and recently the number of people coming to the hospital for consultations and surgery has increased more than usual. However, there are many misconceptions and misconceptions about stone surgery and treatment methods among patients seen in hospitals. Today here on these situations, four aspects of common sense summary, to help you out of the doubts and confusion about the surgery. Myth 1: Large kidney stones must be complicated stones, and small stones are not technically feasible to handle Large stones are not necessarily complicated stones, but mainly depend on their location in the kidney and the nature of the stones to determine the difficulty of surgery. The following situations belong to complex stones 1, high stone location (easy pleural injury); 2, small space in the calyces and pelvis within the kidney; 3, kidney stones with many branches, such as antler-like bifurcations or scattered in multiple calyces; 4, kidney stones with easy tissue bleeding; 5, infected stones wrapped and adhered within the kidney. If one of the above conditions exists, the difficulty of stone surgery increases, and if combined with multiple conditions it is super complicated stones. Therefore, the difficulty of kidney stone surgery does not lie in the size of the stone, but in the distribution, nature and anatomical combination of factors of the stone. The worst kind of situation is a complex kidney stone, but a small one, with serious complications from surgery, which patients and their families often cannot understand and thus serious medical disputes arise. Myth 2: Minimally invasive treatment of complex kidney stones and large kidney stones is not clean and requires open surgery Traditional open kidney stone surgery requires a 20 cm incision in the waist, especially for complex kidney stone surgery, due to the rich blood supply to the kidney, in order to reduce intraoperative bleeding, it is necessary to free the kidney arteries and veins first and give a short block, that is, cut off the kidney blood supply (the longest time should not exceed half an hour, otherwise the kidney function is lost) Then the kidney is dissected, the stone is removed, and then the kidney is stapled up. With the development of minimally invasive techniques, clinical surgical techniques have now entered a new era. Basically, in various clinical disciplines, minimally invasive techniques are constantly replacing traditional open surgery (open surgery) techniques. The shortcomings of open surgery for kidney stones 1. large wound, poor recovery and many complications; 2. if the stones are scattered, it is impossible to remove the net stones by dissecting the kidney, which may lead to a large number of stone residues; 3. due to the intraoperative blocking of the blood supply to the kidney and stapling the kidney parenchyma, resulting in the loss of a large number of kidney units and serious damage to kidney function; 4. intraoperative alteration of the kidney anatomy, prone to complications such as anastomotic stenosis, resulting in second-stage surgical treatment The anastomosis of the kidney can be altered in the second stage of surgery, and even cannot be changed. The “gold standard” for minimally invasive treatment of kidney stones is percutaneous nephrolithotomy, and small stones can be treated with ureteroscopic lithotripsy. Contrary to the general understanding, minimally invasive surgery can overcome the shortcomings of open surgery: it does not change the anatomy of the kidney, preserves the function of the kidney to the maximum, and solves the complications left by open surgery, such as ureteral stenosis. The advancement of minimally invasive techniques and equipment allows stones that cannot be retrieved by open surgery to be handled smoothly in minimally invasive surgery, greatly improving the stone removal rate. Therefore, it is a big mistake to stay in the old view that “open” surgery is better than “minimally invasive” surgery! Myth 3: Kidney stones do not need surgery at all, lithotripsy is enough In the medical world, any disease cannot be dealt with by a single method. Especially in surgery, there is an indication whether surgery is needed or not, called surgical indication. Generally speaking, kidney stones smaller than 2 cm can be considered for extracorporeal shock wave lithotripsy first, but the number of lithotripsy should not exceed 3 times, and the interval between each lithotripsy should be at least 2 weeks. If the lithotripsy is not satisfactory, even stones less than 2 cm still need surgery. Why can’t we desperately do extracorporeal shock wave lithotripsy? The spacing can break hard stones and cause damage to the surrounding kidney tissue. Multiple short interval lithotripsy will surely lead to irreparable kidney function destruction! Kidney stones over 2 cm are indications for surgery and need to be treated surgically. Of course, some kidney stones are not large, but if combined with some special conditions, such as anatomical abnormalities, they also need to be treated surgically, and simple lithotripsy can only deal with the most basic and simple kidney stones. This misconception is largely related to the over-promotion of the effect of lithotripsy in some hospitals, which is a very irresponsible behavior. Many patients have suffered irreversible kidney atrophy after multiple lithotripsy. This concept is the most “deeply rooted” and is the biggest problem for urological stone doctors, and is the biggest cause of clinical disputes. Kidney stones, especially complex kidney stones, are one of the most difficult surgical procedures in urology because of the high technical requirements. In surgical techniques, generally destructive surgery is less difficult than protective surgery, and it is more difficult to protect the kidney than to remove it! Cancer surgery usually involves the removal of an organ, such as kidney cancer, by removing the kidney! Percutaneous nephrological surgery, the purpose of which is to protect the kidney, remove the stones hidden inside the kidney, reduce the damage and preserve the kidney function to the maximum extent. This type of surgery is a level 4 surgery in urology, the highest level surgery, and requires an associate chief physician or higher to lead the surgery to achieve the maximum reduction of complications. For complex stones, multiple channels may be required, up to a maximum of even 5 channels. However, the risk of complications increases with multiple channels. Sometimes the stones are too complicated to be solved by multiple channels, especially when some infected stones are encapsulated in the kidney by adhesions and bleed heavily during the operation, resulting in a high risk of the operation being performed, which cannot be dealt with in the first stage of the operation and must be dealt with in the second stage, or even in the third stage or more. Some people think that having residue after the first surgery is a surgical failure and immediately make a big fuss and question the doctor! This is a huge psychological pressure on all doctors who are engaged in stone treatment.