Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy-free technique achievable?

Abstract

The aim of this study was to present the safety and efficacy of retrograde intrarenal surgery (RIRS) procedures that minimize the intraoperative radiation exposure. The totally endoscopy-guided RIRS technique included the following steps: (a) preoperative assessment of pelvicaliceal system anatomy and stone characteristics, (b) thorough evaluation of the ureters by rigid ureteroscopy, (c) a step-wise approach of introducing the ureteral sheath, (d) gathering stones in the more accessible renal calyx before fragmenting them, and (e) a modified holmium laser technique. The RIRS procedures performed by a single surgeon between October 2012 and October 2013 in consecutive patients with renal stones were retrospectively reviewed. The mean stone size was 1.4 ± 0.4 (range 0.8-2.0) cm. The median operative time was 74.5 min. Fluoroscopy was only used in one patient who had a double collecting system with two ureters. The stone-free status was achieved in 134 (95.7%) patients one month after surgery. Five (3.6%) patients had minor complications, including hematuria and fever. No major intraoperative complication was observed. We believe that with appropriate preparation, RIRS without fluoroscopic guidance can be safely and efficiently performed by experienced urologists in selected patients with renal stones.

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

“…In a recently published paper, the authors evaluated a fluoroscopy-free RIRS technique for renal stones and achieved stone-free status in 95.7% of the patients. [10] In that study, the authors defined the stone-free status as the absence of any fragments or residual fragments <2 mm in diameter on plain abdominal radiography or ultrasound (US) imaging. It is well known that CT, which was used in the present study to evaluate the success rate, is more sensitive for detecting renal stones than both US and plain radiography (96.6%, 45% and 44-77%, respectively).…”

“…[4,5] Therefore, fluoroscopy-free techniques and radiation exposure-minimising techniques have become popular in the field of urology. [6][7][8][9][10] The present study aimed to determine the outcomes of our fluoroscopyfree RIRS technique and evaluate its safety and efficacy.…”

Retrograde intrarenal surgery for renal stones - Part 2

“…For this reason, in order to decrease the exposed dosage, decreased use of fluoroscopy or fluoroscopy-free techniques have been reported. Peng et al [8] evaluated the fluoroscopy-free RIRS in 144 patients with a mean stone dimension of 1.4±0.4 cm. They required fluoroscopy in only 1 patient who had a duplicated collecting system.…”

Prospective randomized comparison between fluoroscopy-guided ureteroscopy versus ureteroscopy with real-time ultrasonography for the management of ureteral stones

“…In another study by Peng et al . [12] they showed that retrograde intrarenal surgery is feasible without fluoroscopy. In that study 95.7% of stone-free rate was achieved over 1 month with minimal complication.…”

“…In another study by Peng et al . [12] using low radiation fluoroscopy, they were able to keep the total fluoroscopy time 0–35 s with excellent success and low complications rate. In another study by Scarpa et al .,[13] they performed successful rigid ureteroscopy in 15 pregnant patients with the help of ultrasound only.…”