Fluoroscopy free flexible ureteroscopy with holmium: Yttrium-aluminium-garnet laser lithotripsy for removal of renal calculi

Abstract

ObjectiveTo evaluate the feasibility of access sheath insertion and ureteric stent placement without image guidance in flexible ureteroscopic lithotripsy with holmium:yttrium-aluminium-garnet laser for renal stones.Patients and methodsBetween March 2014 and October 2015, 80 patients with renal stones treated with flexible ureteroscopic laser lithotripsy were evaluated. Indications for surgery were renal obstruction, failed shockwave lithotripsy (SWL), stones in polycystic kidneys, and mal-rotated kidneys. A 6.5-F Cobra flexible ureteroscope was used in all cases with an access sheath of 12 F, 35/45 cm in length. Fluoroscopy was not intended for use in all cases and postoperative JJ stenting was optional. The perioperative complications were listed and the collected data were analysed.ResultsThe study included 80 patients (66 male, 14 female), with a mean (SD; range) age of 48.2 (8; 28–54) years and a stone burden of 13 (3.5; range 6–23) mm. In all, 26 patients had a stone burden of >15 mm and 48 patients had lower calyceal stones. The mean (SD; range) operative time was 71.5 (20; 25–130) min. Overall, 76 (95%) access sheath insertions were performed successfully without the use of fluoroscopy. JJ stenting was used in 22 patients (27.5%). The mean (SD; range) hospital stay was 10 (8.5; 10–36) h. After one session, a stone-free rate (SFR) of 87.5% was achieved (93.3% for stones of <15 mm). A single session was successful in 87.9% of cases with lower calyceal stones, with a SFR of 91.7% for post-SWL failure cases. The perioperative complication rate was 15%.ConclusionAccess sheath insertion without fluoroscopic guidance is feasible. This technique reduces radiation exposure in patients requiring flexible ureteroscopy.

Advances in Lasers for the Treatment of Stones—a Systematic Review

“…Studies have confirmed the positive correlation between stone burden and radiation exposure during laser lithotripsy. Hence, clinicians should consider strategies to reduce the total radiation exposure, such as using pulsed instead of continuous fluoroscopy [ 121 ], although there are even defenders of using no fluoroscopy at all [ 122 ].…”

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

“…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] .…”

Flexible ureteroscopy lithotripsy combined with metallic ureteral stents for the treatment of patients with upper urinary tract calculi

“…were performed under local anesthesia by urologists. The FURS protocol was standardized to a previous study (11). The stone was positioned in the excretory phase.…”