Abstract
ABSTRACT Objective: To describe the feasibility of treating proximal ureteric and renal stones using flexible ureteroscopy (fURS) or a double approach (mini-percutaneous nephrolithotomy [PCNL] + fURS) without any use of radiation. Patients and methods: We retrospectively reviewed the data of all patients operated by one surgeon for retrograde endoscopic removal of renal and ureteric lithiasis performed between June 2015 and January 2019 in our institution. Patients with anatomical complexities, high-burden stone disease (diameter >20 mm), and medical comorbidities (anti-platelet drug administration) were included in our study. Outcomes analysed included complication rate, stone-free rate (SFR, defined as no residual stone >1 mm), and repeat procedure rate. Results: In all, 183 consecutive URS for proximal ureteric and renal lithiasis were conducted. C-arm fluoroscope guidance was not required, not even in the complex cases. Simultaneous ultrasonography and fURS guidance was used in patients where the mini-PCNL approach was indicated. Lead aprons were not needed by the operating room staff in any of the operations. The SFR was 91.8% after the first procedure, with no Clavien–Dindo Grade III or IV complications. Conclusion: Our present series shows clearly that the fURS and mini-PCNL approach under fURS control is a feasible and safe technique for experienced surgeons. Patients had a high SFR and no technique-related complications, with no additional risk of X-ray exposure. However, a prospective study is required to test the reproducibility of this technique. Abbreviations: GMSV: Galdakao-modified supine Valdivia; ICRP: International Commission on Radiological Protection; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; OR: operating room; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; UAS: ureteric access sheath; (f)URS: (flexible) ureteroscopy; US: ultrasonography
Highlights
Conventional endourology has always been related to fluoroscopic guidance since its development in the mid-20th century
Patients with urolithiasis are more likely to have several CTs during their lifetime with increased risk of other X-ray exposure during endourological procedures. These facts have caused a huge increase in medical radiation exposure, clearly described in a study conducted in the United States, which compared the annual per capita radiation expo sure in 1980 and 2006 (0.54 vs 3.0 mSv respec tively) [6,7]
We describe the feasibility of 183 consecutive proximal ureteric and renal stones using flexible URS or a double approach without any use of radiation
Summary
Conventional endourology has always been related to fluoroscopic guidance since its development in the mid-20th century. The prevalence of urin ary lithiasis is 2–3% in general population [4], with a recurrence rate estimated at 30–40% within 5 years [5] Based on these statistics, patients with urolithiasis are more likely to have several CTs during their lifetime with increased risk of other X-ray exposure during endourological procedures. Patients with urolithiasis are more likely to have several CTs during their lifetime with increased risk of other X-ray exposure during endourological procedures These facts have caused a huge increase in medical radiation exposure, clearly described in a study conducted in the United States, which compared the annual per capita radiation expo sure in 1980 and 2006 (0.54 vs 3.0 mSv respec tively) [6,7]. Patients with high-burden stone disease (diameter >20 mm) and medical comorbidities (anti-platelet drug adminis tration) were included in the study
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