Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones

Abstract

Objective: The aim of this study was to present outcomes of our patients who had undergone retrograde intrarenal surgery (RIRS) with fluoroscopy-free technique and evaluate the efficacy and safety of the technique. Material and methods:Between January 2013 and June 2015 the outcomes of 93 patients who had undergone RIRS with fluoroscopy-free technique were retrospectively evaluated. Our RIRS technique involved preoperative assessment of ureter by semi-rigid ureteroscope, inserting guidewire through semi-rigid ureteroscope, inserting ureteral access sheath over the guidewire with the visiual guidance of semi-rigid ureteroscope, passing flexible ureteroscope through the sheath, dusting the stone with holmium laser, rechecking the ureter with semirigid ureteroscope and inserting double J stent through semi-rigid ureteroscope. Low-dose computerized tomography scan was performed to all patients in postoperative first month and the results were classified as stone-free (absence of any fragment), clinically insignificant residual fragments (CIRF) (≤4 mm) and residual stone.Results: Study population consisted of 62 (66.6%) male and 31 (33.3%) female patients with a mean age of 47.8±14 (range 14-93) years. Mean stone size was 14.7±5 (7-32) mm. Median operative time was 72 (30-125) minutes. Stone-free rate was achieved in 65 (69.9%) patients while CIRF was achieved in 13 (13.9%) and residual stones were detected in 15 (16.1%) patients. Five patients (5.37%) had minor complications, including hematuria and fever. No major complications were observed. Conclusion:Fluoroscopy-free technique is effective and safe technique in management of renal stone. Furthermore fluoroscopy-free technique can protect the surgeon from the negative effects of radiation.Keywords: Flexible ureterorenoscopy; fluoroscopy; nephrolithiasis.Cite this article as: Çimen Hİ, Halis F, Sağlam HS, Gökçe A. Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones. Turk J Urol 2017; 43: 309-12

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

“…In the present study, the SFR was 90.37% after 6 weeks of intervention. This finding is proportionate to comparable studies that determined the SFR of 65%–92% [2] , [39] , [40] , [41] , [42] , [47] , [48] , [49] , [50] . Moreover, the results were related to stone size; the highest SFR (100%) was achieved in stones <10 mm, and the lowest SFR (77.7%) in stones >30 mm ( p =0.0005).…”

“…From these results, we conclude that fluoroless FURSL is a safe and feasible procedure with high SFR and low morbidity compared to other studies [39] , [40] , [41] .…”

“…Technological advances in flexible URS, such as the ability to get smaller and higher image quality, facilitate navigation of the ureter, renal pelvis, and calyces with excellent visualization and increase the experience of the urologist positively, have made flexible URS safer and more effective, allowing the achievability of radiation-free URS [27] , [32] , [33] , [34] , [35] , [36] . Several studies have demonstrated that reduced radiation and fluoroless protocol during flexible URS can be done safely, including UAS insertion, balloon dilation, and the placement of double-J stents, with no impact on the operation's success, time, or complication rates; thus, this process does not increase technical difficulty [27] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] .…”

Retrograde intrarenal surgery technique without using fluoroscopy and access sheet in the treatment of kidney stones

“…In another study, where RIRS was applied to patients including 62 (66.6%) males and 31 (33.3%) females with a mean age of 47.8 ± 14 years (range: 14-93), mean stone size was reported as 14.7 ± 5 mm (range: 7-32). In this study, an ureteral access sheet was used, and it was reported that fluoroscopy was not used in any of the cases and that no serious complications were encountered (18). In another study by Kirac et al, it was reported that a single dose was used to decrease the use of fluoroscopy when verifying the location of the ureteral access sheet (19).…”

A focused review on materials and generations of coronary stents

“…Then doctor guide the catheter up through body to coronary arteries. Using X-ray 17,18 that called fluoroscopy, 19,20 video, and special dyes helps doctor to guide the catheter up into the blocked coronary artery. In the next step doctor pass a small wire through the catheter and then the next catheter that has a small balloon attached to it.…”