You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 20122197 FLUORO-LESS URETEROSCOPY: MINIMIZING INTRAOPERATIVE RADIATION DURING URETEROSCOPIC PROCEDURES Ryan Hsi and Jonathan Harper Ryan HsiRyan Hsi Seattle, WA More articles by this author and Jonathan HarperJonathan Harper Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2371AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fluoroscopy usage during endoscopic procedures exposes the patient and operating room staff to ionizing radiation. Little is known regarding the average range of exposure during these cases. Mean fluoroscopy usage time during ureteroscopy reported from recent literature is between 15-183 seconds. The purpose of this study was to determine if a minimalist approach to fluoroscopy usage during ureteroscopy could reduce overall intraoperative fluoroscopy time. METHODS Over a 9 month period, fluoroscopy usage for all cases involving retrograde ureteroscopy for a single surgeon was prospectively recorded. A protocol was developed to access the ureter with the ureteroscope without fluoroscopy usage, and minimize radiation at every step (Figure 1). A retrospective chart review was then performed on patient factors and intraoperative events. Figure 1. Utilization of fluoroscopy during specific steps in ureteroscopy. Step Protocol Prior to procedure Surgeon controlled fluoroscopy pedal Scout film Unnecessary; C-arm positioned based on external visual cues Retrograde pyelogram Unnecessary unless difficult access to upper urinary tract Initial wire placement Place under tactile guidance or directly through ureteroscope Ureteroscopic access Place under tactile guidance to mid ureter over wire or drive directly into ureter Stent placement Single-tap pedal to visualize proximal stent curl, visualize distal curl cystoscopically RESULTS Fluoroscopy usage during ureteroscopic cases was utilized on 109 renal units in 73 consecutive patients. The indications for ureteroscopy included the treatment of stones (84%), diagnosis and/or biopsy (15%), and laser incision of infundibular stenosis (1%). Of the 102 renal units with fluoroscopic usage data, total mean and median fluoroscopy time was 2.8 and 1.0 seconds (0-31 seconds), respectively. Excluding fluoroscopy usage to confirm ureteral stent placement, 72% of all cases did not require any fluoroscopy time, and 82% required 2 seconds or less. For the last 44 consecutive renal units, total mean and median radiation dose was estimated at 0.5 mGy and 0.4 mGy (0.0-2.3 mGy), respectively. The most common reasons for utilization of fluoroscopy during ureteroscopy included aberrant anatomy, severely impacted ureteral stone, or difficult navigation due to a tight ureter. There were no intraoperative complications. CONCLUSIONS The reduced fluoroscopy protocol resulted in minimal fluoroscopy time and radiation exposure, significantly lower than reported in the literature. Fluoro-less ureteroscopy is safe and feasible in the majority of ureteroscopic cases and lessens exposure to patients and staff. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e886 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi Seattle, WA More articles by this author Jonathan Harper Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...