Abstract
ABSTRACTObjectives: To evaluate the safety and effectiveness of flexible ureterorenoscopy (fURS) with holmium laser lithotripsy for treating kidney stones without fluoroscopy as method of best practice for patients and endourologists.Patients and Methods: All patients treated for kidney stones by fURS with holmium laser lithotripsy from February 2016 to February 2017 were retrospectively evaluated. The patients’ demographic characteristics, stone features (size, number, and location), surgical variables (use of fluoroscopy, operative and fluoroscopy time), complications, and success rate (employing stone-free rate [SFR]), were included in the analysis.Results: In all, 100 patients met the inclusion criteria: 33 fURS were performed under fluoroscopy (Group 1) and 67 without it (Group 2). The mean operating time was 94.33 vs 98.29 min (P = 0.888), respectively. The mean stone volume was 78.5 vs 82.4 mL (P = 0.885), respectively. The SFR was 63.6% and 64.2% (P = 0.771), the perioperative complications rate was 18.2% vs 11.9% (P = 0.285), and the postoperative complications rate was 24.2% and 10.4%, in groups 1 and 2 respectively (P = 0.174).Conclusions: fURS with holmium laser lithotripsy without fluoroscopy was a feasible and safe treatment for kidney stones. There was no difference between the use of fluoroscopy or not regarding complications or SFR. Thus, we can reduce the risks of radiation exposure to patients and medical staff whilst maintaining surgical success. However, multicentre randomised controlled studies are necessary to evaluate fluoroless URS further and to confirm our present results.Abbreviations: PTFE: polytetrafluoroethylene; SFR: stone-free rate; (f)URS: (flexible) ureterorenoscopy/ureterorenoscopies; US: ultrasonography
Highlights
IntroductionThe incidence of urinary stones has increased around the world. This rise has led to an increase of 83% in the number of flexible ureterorenoscopies (fURS) performed in the USA between 1994 and 2004
In recent years, the incidence of urinary stones has increased around the world
We included all patients with renal stones of
Summary
The incidence of urinary stones has increased around the world. This rise has led to an increase of 83% in the number of flexible ureterorenoscopies (fURS) performed in the USA between 1994 and 2004. The USA Food and Drug Administration (FDA) has been concerned about fluoroscopy radiation exposure of patients and surgeons and recently has recommended reducing fluoroscopy as much as possible in all surgical procedures as a best practice. Many authors have published various techniques and protocols for reducing radiation exposure as much as possible in endourological stone treatments. All of these previous studies still used fluoroscopy at least in one step of the surgical procedure, still exposing the patients with stones and surgeons to some radiation, contributing to increasing the allowed annual dose of radiation. Even with the vast amount of studies about low radiation protocols, to our knowledge, this is the first study to evaluate a protocol of fURS completely free of radiation for the treatment of renal stones [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]
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