Safety and reliability of fluoroscopy-free technique in retrograde intrarenal surgery.

Abstract

Traditional retrograde intrarenal surgery is performed under fluoroscopic guidance. In the present study, we assessed the efficacy and safety of retrograde intrarenal surgery without fluoroscopic guidance in selected patients with renal and proximal ureteral stone disease. Between October 2013 and August 2016, a total of 350 patients who underwent retrograde intrarenal surgery for upper urinary tract stone disease were retrospectively analyzed. Ninety-five (Group 1) and 255 (Group 2) patients underwent retrograde intrarenal surgery with and without fluoroscopy guidance, respectively. We documented complications and success rates of the procedures retrospectively. The mean age of the patients was 45.3 years. The mean stone size was 14.5±5.5 (5-30) mm and 13.7±5.2 (4-30) mm in Group 1 and 2, respectively (P=0.197). The stone-free rates one month after surgery were 86.3% and 87% in Group 1 and 2, respectively (P=0.739). The overall incidence of intraoperative complication was 16.3%. In Group 1, incidence of intraoperative complication was 17.9% (N.=17) while in Group 2 incidence was 15.7% (N.=40) (P=0.620). The overall postoperative complication rate was 5.1%. Postoperative complications developed in seven patients (7.4%) in Group 1 and in 11 patients (4.3%) in Group 2 (P=0.250). Fluoroscopy-free retrograde intrarenal surgery seems to be technically feasible and safe for the treatment of renal and proximal ureteral stone disease in uncomplicated selected cases.