Systematic Review and Meta-Analysis Comparing Fluoroless Ureteroscopy and Conventional Ureteroscopy in the Management of Ureteral and Renal Stones

Subiela, José Daniel; Kanashiro, Andrés; Emiliani, E.; Villegas, Sergio Tenopala; Sánchez-Martín, F.M.; Millán, Félix; Palou, Joan; Angerri, Oriol

doi:10.1089/end.2020.0915

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…In the present study, flexible ureteroscopy and percutaneous nephrolithotomy were used to treat patients with multiple renal calculi. Our results showed that although the two methods had a similar removal rate effect, flexible ureteroscopy had a significant advantage in reducing surgical trauma by reducing the damage to renal function and shortening postoperative rehabilitation [ 12 – 14 ]. However, the flexible ureteroscope can retrograde into the ureter, renal pelvis, and renal calyces through the natural body cavities, more consistent with the physiological characteristics of the human body, thus avoiding damage to body organs and tissues [ 12 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed that although the two methods had a similar removal rate effect, flexible ureteroscopy had a significant advantage in reducing surgical trauma by reducing the damage to renal function and shortening postoperative rehabilitation [ 12 – 14 ]. However, the flexible ureteroscope can retrograde into the ureter, renal pelvis, and renal calyces through the natural body cavities, more consistent with the physiological characteristics of the human body, thus avoiding damage to body organs and tissues [ 12 , 15 ]. Moreover, when the ureter is severely obstructed or distorted, a flexible ureteroscope can be adopted for treatment, convenient to avoid blind operation and damage to the kidney and other functions.…”

Section: Discussionmentioning

confidence: 99%

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Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi

Zhu

Zhang

2022

Disease Markers

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Objective. Renal calculi are a common type of urological calculi and are associated with morbidity. This study was aimed at exploring the effect of flexible ureteroscopy and nephroscopy on stone removal in patients with multiple renal calculi. Method. This randomized controlled trial included a total of 78 cases with multiple renal calculi in our hospital. The patients were randomly divided into the study and control groups and treated with flexible ureteroscopy and percutaneous nephrolithotomy with pneumatic ballistics, respectively. The surgery condition, levels of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), keratocyte growth factor (KGF), renal function indices, and the incidence of complications were analyzed before and after surgery in the two groups. Result. The operation time, the postoperative analgesia pump application time, one-time stone removal rate, the intraoperative blood loss, and hospital stay of the study group were significantly lower than those of the control group. Postsurgery, the levels of PGE2, PGF2α, and KGF in the study group were significantly lower than those in the control group. The serum levels of SCR, BUN, and NGAL in the study group were significantly lower than those in the control group. In addition, the incidence complications in the study group were significantly lower. Conclusion. Flexible ureteroscopy and laser lithotripsy under nephroscopy were equally effective against multiple renal calculi. Flexible ureteroscopy reduced surgical trauma without affecting renal function and had a low incidence of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi

Zhu

Zhang

2022

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“…Increasingly, outcomes from low-dose fluoroscopy as well as fluoroless endourological procedures are being reported [ 19 ]. The latter implement measures such as tactile guidance and even US to avoid fluoroscopy [ 8 •].…”

Section: Introductionmentioning

confidence: 99%

ALARA in Urology: Steps to Minimise Radiation Exposure During All Parts of the Endourological Journey

et al. 2022

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Purpose of the Review The global burden of kidney stone disease (KSD) and its management relies on ionising radiation. This includes the diagnosis, treatment and follow-up of KSD patients. The concept ‘As Low As Reasonably Achievable’ (ALARA) developed in response to the radiation risks and the key principles include optimisation, justification and limitation of radiation. This article provides an overview of the topic including background to the risks and steps that can be taken during all stages of endourological management. Recent Findings Our review suggests that ionising radiation is an invaluable tool in delineating the anatomy, localising disease, guiding manoeuvres and monitoring treatment in patients with KSD. It therefore plays an integral role in many stages of patient care; preoperatively, intraoperatively and postoperatively. The reduction of radiation pre- and post-surgical intervention relies on the use of low-radiation CT scan and ultrasound scan. It can also be achieved through various intraoperative techniques or fluoroless techniques in selected patients/procedures, customised to the patients and procedural complexity. Summary There are many parts of the patient journey where exposure to radiation can take place. Urologists must be diligent to minimise and mitigate this wherever possible as they too face exposure risks. Implementation of strategies such as teaching programmes, fluoroscopy checklists and judicious use of CT imaging among other things is a step towards improving practice in this area.

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“…A meta-analysis conducted by Subiela et al concluded that fluoroless URS offers a similar stone-free rate to that provided by fluoroscopy-guided URS without any increase in operative time, hospital stay, secondary procedures, or patient morbidity [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Urolithiasis is a worldwide health problem that affects about 12% of males and 6% of females during their lifetime [ 1 ]. Distal ureteric stones represent 70% of ureteric stones, which are mostly symptomatic [ 2 ]. Ureteroscopy (URS) is considered a standard and efficient treatment for distal third ureteric stones, especially in stones with the low possibility of spontaneous passage or failed medical expulsive therapy [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound versus fluoroscopy-guided ureteroscopy for distal ureteric stones in adults

Reda

Abdelsalam

Shehata

et al. 2022

Arab Journal of Urology

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Objective To evaluate the safety and efficacy of ultrasound (US) as alternative to fluoroscopy for guidance of ureteroscopy (URS) during treatment of distal ureteric stones in adults. Materials and methods This study enrolled 80 patients older than 18 years presented with a single distal ureteric radio-opaque stone of ≤15 mm in longest diameter. Patients were randomized and allocated into two groups: the fluoroscopy group and the ultrasound group (n = 40 patients in each group). Patients with bilateral ureteric stones, solitary kidney, ureteric congenital anomalies, history of failed ureteroscopy, history of ureteric surgery, patients with uremia and pregnant women were excluded. Patients’ demographics, stone characteristics, operative data, stone-free status, hospital stay and complications were evaluated in both groups. Results No statistically significant difference between both groups was found regarding patients’ demographics and stone characteristics. Also there was no statistically significant difference in comparing fluoroscopy group versus ultrasound group regarding operative time (29.48 ± 15.3 versus 31.28 ± 18.24 min; P = 0.83), stone-free rate (97.5% versus 95%; P = 1.0), overall complications (15% versus 12.5%; P = 0.75), or hospital stay (1.17 ± 0.6 versus 1.02 ± 0.16 days; P = 0.12). Four patients (10%) in the ultrasound group required the addition of fluoroscopy beside ultrasound. Conclusion Ultrasound is effective in guidance during ureteroscopy for distal ureteric stones. It was comparable to fluoroscopy in terms of stone free rate, operative time, overall complications, and hospital stay. However, fluoroscopy must be available to be used when needed.

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Systematic Review and Meta-Analysis Comparing Fluoroless Ureteroscopy and Conventional Ureteroscopy in the Management of Ureteral and Renal Stones

Cited by 10 publications

References 37 publications

Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi

Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi

ALARA in Urology: Steps to Minimise Radiation Exposure During All Parts of the Endourological Journey

Ultrasound versus fluoroscopy-guided ureteroscopy for distal ureteric stones in adults

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