Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature—Tips and Tricks

Emiliani, Esteban; Kanashiro, Andrés; Chi, Thomas; Manzo, Braulio Omar; Angerri, Oriol; Somani, Bhaskar K.

doi:10.1007/s11934-020-00979-y

Cited by 21 publications

(11 citation statements)

References 62 publications

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“…However, dealing with multiple complicated stones or less experienced urologists may pose challenges with the RF RIRS technique, warranting exploration in future studies. Nonetheless, considering the growing necessity of conducting a multicenter, prospective RCT to evaluate RF RIRS, 6 our study showed valuable results.…”

Section: Discussionmentioning

confidence: 91%

“…Radiation-free (RF) RIRS has been described in adult and pediatric urology. 1,[4][5][6][7] However, there are no prospective, multicenter-based, randomized, controlled trials (RCTs) comparing the success rates or safety between radiation-usage (RU) and RF RIRS. We hypothesized that RF RIRS is noninferior to RU RIRS and compared the safety and efficacy of RF RIRS with RU RIRS using a multicenter-based RCT.…”

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confidence: 99%

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The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial

Chung,

Kang,

Jung

et al. 2024

Journal of Urology

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Purpose: Fluoroscopy is usually required during retrograde intrarenal surgery (RIRS). Although fluoroscopy is considered necessary for effective and safe RIRS, there is growing awareness regarding radiation exposure risk to patients and surgeons. We conducted a multicenter-based, randomized, controlled trial to compare the safety and effectiveness of radiation-free (RF) RIRS with radiationusage (RU) RIRS for kidney stone management. Materials and Methods: From August 2020 to April 2022, patients with a unilateral kidney stone ( 20 mm) eligible for RIRS were prospectively enrolled in 5 tertiary medical centers after randomization and divided into the RF and RU groups. RIRS was performed using a flexible ureteroscope with a holmium:YAG laser. The primary end point of this study was the success rate, defined as complete stone-free or residual fragments with asymptomatic kidney stones 3 mm. The secondary end point of this study was ascertaining the safety of RF RIRS. The success rates were analyzed using a noninferiority test.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial

Chung,

Kang,

Jung

et al. 2024

Journal of Urology

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“…Another approach is performing endourological stone removal without fluoroscopy. This technique was also shown to be feasible even for PCNL without increased risk to patients or inferior stone free rates [27,28]. However, this is not applicable to all patients and in many centres, the use of fluoroscopy is part of the stone treatment and complication management.…”

Section: Discussionmentioning

confidence: 99%

Personalized Prediction of Patient Radiation Exposure for Therapy of Urolithiasis: An Application and Comparison of Six Machine Learning Algorithms

Huettenbrink

Hitzl

Distler

et al. 2023

JPM

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The prediction of radiation exposure is an important tool for the choice of therapy modality and becomes, as a component of patient-informed consent, increasingly important for both surgeon and patient. The final goal is the implementation of a trained and tested machine learning model in a real-time computer system allowing the surgeon and patient to better assess patient’s personal radiation risk. In summary, 995 patients with ureterorenoscopy over a period from May 2016 to December 2019 were included. According to the suggestions based on actual literature evidence, dose area product (DAP) was categorized into ‘low doses’ ≤ 2.8 Gy·cm2 and ‘high doses’ > 2.8 Gy·cm2 for ureterorenoscopy (URS). To forecast the level of radiation exposure during treatment, six different machine learning models were trained, and 10-fold crossvalidated and their model performances evaluated in training and independent test samples. The negative predictive value for low DAP during ureterorenoscopy was 94% (95% CI: 92–96%). Factors influencing the radiation exposure were: age (p = 0.0002), gender (p = 0.011), weight (p < 0.0001), stone size (p < 0.000001), surgeon experience (p = 0.039), number of stones (p = 0.0007), stone density (p = 0.023), use of flexible endoscope (p < 0.0001) and preoperative stone position (p < 0.00001). The machine learning algorithm identified a subgroup of patients of 81% of the total sample, for which highly accurate predictions (94%) were possible allowing the surgeon to assess patient’s personal radiation risk. Patients without prediction (19%), the medical expert can make decisions as usual. Next step will be the implementation of the trained model in real-time computer systems for clinical decision processes in daily practice.

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“…However, a review by Emiliani et al described the possibility of fluoroless endourological surgery for stone disease. They found that low radiation or completely fluoroless procedures are feasible and safe and that a specific preoperative checklist should be used to reduce radiation exposure [ 15 ]. A study by Mohey et al confirms these findings in a randomized controlled trial for endourological management of distal stones.…”

Section: Discussionmentioning

confidence: 99%

Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?

Henderickx

Brits

Zabegalina

et al. 2022

Cent european J Urol

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Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.

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Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature—Tips and Tricks

Cited by 21 publications

References 62 publications

The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial

The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial

Personalized Prediction of Patient Radiation Exposure for Therapy of Urolithiasis: An Application and Comparison of Six Machine Learning Algorithms

Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy?

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