Comparison of Retrograde Intrarenal Surgery with and Without Fluoroscopy for Renal Stone Treatment

Abstract

Objective: To compare fluoroscopy-free retrograde intrarenal surgery (RIRS) with routine RIRS with fluoroscopy for urolithiasis treatment in terms of efficacy and safety. Prospective quasi-experimental study. Hitit University Çorum Erol Olçok Training and Research Hospital, Department of Urology, Çorum, Turkiye August 2019-2020. Materials and Methods: Pre-operative and postoperative data for 98 patients who underwent RIRS using fluoroscopy and 100 patients who underwent RIRS without fluoroscopy were prospectively assessed. Patients who did not provide preoperative consent, were pregnant, or had a clotting disorder, active urinary system infection, or anatomic abnormalities such as ectopic kidney were excluded from the study. In the technique without fluoroscopy, the fluoroscopic device was ready for use in surgery; however, all manipulations were performed by all-seeing access without fluoroscopy. Patients beginning without fluoroscopy who required fluoroscopy were not included in the study. Results: The mean stone size was 18.5±2.31 (5-30) mm (in the fluoroscopy group 17.2±25.3 mm, in the non-fluoroscopy group 19.8±20.9). Stone-free rates were similar between the groups (91% in the fluoroscopy group and 90% in the non-fluoroscopy group) (p=0.683). The mean duration of fluoroscopy use in the fluoroscopy group was 8.76±9.50 s. A Clavien 3b complication (perirenal hematoma) was observed in one patient (in the fluoroscopy group), which regressed with observation. Minor complications were observed in both groups: fever in 7 patients (3.6%), hematuria in 7 patients (3.6%), and steinstrasse in 1 patient (0.5%). Conclusion: Fluoroscopy-free RIRS may be applied effectively and safely by endourologists for patients with urolithiasis, similar to the routine method with fluoroscopy.

Keywords

• renal calculi
• endourology
• fluorroscopy-free retrograde intrarenal surgery