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

Abstract

Objective To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL) for treating renal stones. Methods Between May 2015 and May 2017, 135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated. Our technique involved a semi-rigid ureteroscopic assessment of the ureter, and the guidewire was left in situ to railroad the flexible ureteroscope. A holmium laser was used to fragment and dust the stones; fragments were neither grasped nor collected. Results The study population consisted of 135 patients including 85 males (62.96%) and 50 females (37.04%) with a mean age of 40.65 years (range: 3–70 years) were evaluated. The mean stone size was 17.23 mm (range: 8–41 mm). Complete stone-free status was achieved in 122 (90.37%) patients and clinically insignificant residual fragments (CIRF) in two (1.48%), while residual stones were still present in 11 (8.15%) patients. Postoperative complications occurred in 23 (17.4%) cases and were mostly minor, including fever in 17 (12.6%), pyelonephritis in four (3.0%), subcapsular hematoma in one (0.7%) and steinstrasse in one (0.7%). These complications were Clavien I-II, GI in 17 (12.6%) patients, GII in five (3.7%), and Clavien IIIb in one (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 min, and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis ( p <0.05). Conclusion Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.

Evaluation of mini-PCNL and RIRS for renal stones 1–2 cm in an economically challenged setting: A prospective cohort study

“…On the other hand, flexible ureterorenoscopy (fURS) has developed enormously through the evolution of laser technology, the miniaturization of the scope diameter with simultaneously offering working channels large enough to accommodate all necessary accessories, enhanced digitalized image quality, and enhanced mechanical properties such as deflection and durability. This has greatly expanded the indications of retrograde intrarenal surgery (RIRS) by means of fURS [ [6] , [7] , [8] ].…”

Üreteral giriş kılıfı ve floroskopi kullanılarak yapılan retrograd intrarenal cerrahinin karşılaştırmalı değerlendirilmesi: böbrek taşı tedavisinde retrospektif bir analiz

“…In some studies comparing the results of operations performed without fluoroscopy, no significant difference was found in stone-free rate and complication development. 10,19, 20 When we compare the patient groups with and without fluoroscopy, our stone-free and complication rates show that we can perform effective surgery without fluoroscopy. Studies in the literature compare surgeries performed with and without the use of fluoroscopy alone, those performed with and without the use of UAS alone, and the results of the surgeries performed without fluoroscopy and UAS.…”

Cirug�a intrarrenal retr�grada sin fluoroscopia: una alternativa endosc�pica eficaz y segura para el manejo de litiasis renal

“…Güner, et al analizaron de forma prospectiva y aleatoria a 58 pacientes, los cuales dividieron en pacientes a los que se les realizó CIRR con y sin fluoroscopia. No hubo diferencia estadística significativa en cuanto a las complicaciones y litiasis residual, atribuyendo para estos escenarios la influencia en gran medida de la técnica y habilidad del cirujano 9 .…”