Presented by: Ricardo Emanuel Domínguez Castillo MD
Hospital General Dr Manuel Gea González

Introduction

Actually, the gold standard for the management of ureteral and kidney stones is semirigid and flexible ureteroscopy.

92.64% of the practitioners in Latin America consider URS as the first choice treatment for ureteral and kidney stones. About the different techniques of treatment of lithiasis, 98.5% of the physicians routinely practice semi-rigid URS and 78.2% flexible URS.

Data have shown that the rate of radiation exposure during a URS can range from 1.2 to 29.7 mGy. These type of patients with an acute stone episode undergo an average of four diagnostic imaging studies in a year, which have been calculated to yield a total cumulative dose of 29.7 mGy.

Although the radiation dose in ureteroscopy is low, we must consider that during this procedure different people are exposed to this risk (patients, doctors, nurses, etc.). Currently, guidelines do not recommend or are against the use of fURS in practice. However, this practice aims to reduce radiation exposure in the operating room without having a lower efficiency in terms of results. We present the experience in fluoroless ureteroscopy at our center.

Materials

We performed 164 procedures between rigid and flexible ureteroscopy, all of them fluoroless, for resolution of renal and ureteral lithiasis in a period of  9 months between April 2022 and January 2023.  All steps of each procedure (safety guidewire placement, rigid ureteroscopy, second guidewire ascent, ureteral access sheath placement, pyeloscopy, lithotripsy, and JJ stent placement) were performed fluoroless.

 

Patient demographics and stone features (number, size and location) were evaluated preoperatively. The results of the procedures were evaluated with the stone-free rate, surgical time, complications, and hospital readmissions.

Results

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A total of 164 procedures was performed, of them 82 (50%) were woman  and 82 men (50%) with an average age of 45.3 years. The stones features were: average stone number 1.39, a median stone diameter of 9.39 mm, the localization of the stones was distal ureter 14 (8.5%), medium ureter 45 (27.4%), proximal ureter 22 (14.1%) and renal 83 (50%). The surgery performed was 59 rigid ureteroscopy (36%), 105 flexible ureteroscopy (64%). The mean operative time was 65.59 min. The stone free rate was 81%. The rate of complications was 2.5% including one patient with a Clavien Dindo >III (ureteral stenosis).

Conclusion

Fluoroless ureteroscopy is demonstrated as a safe technique for the patient with results comparable to the conventional technique and a low range of complications, therefore this technique can be taken into account in patients whose context exposes them to more radiation as patients with recurrent lithiasis, underlying metabolic problems in whom a greater number of control studies are necessary.

Funding

None

Lead Authors

Carlos Martínez Arroyo, MD
Hospital General Dr. Manuel Gea González

Co-Authors

Daniel Alejandro Arreola Ramírez, MD
Hospital General Dr. Manuel Gea González

Alejandro Haddad Servín, MD
Hospital General Dr. Manuel Gea González

Antonio Yaromin Muñoz López, MD
Hospital General Dr Manuel Gea González