Fluoroless versus conventional ureteroscopic lithotripsy: the way forward

Abstract

Objectives: The purpose of this study is to determine the feasibility, outcomes and safety of fluoroless URSL (fL-URSL) compared to conventional URSL with fluoroscopy (cf-URSL). Patients & Methods: This is a prospective single-centre randomised controlled trial that recruited adults with unilateral ureteral stones. Patients with a history of stricture, complicated ureteral anatomy, no stone intra-operatively and solitary kidneys were excluded. The reported difference of radiation dosage between fL- and cf-URSL was 45.3 mGy. For a study power of 90% and a dropout rate of 20%, 60 patients were randomised (1:1) to fL- or cf-URSL. In fL-URSL, standby fluoroscopy was available for safety. Fluoroscopy use, radiation dosage, perioperative complications and operative outcomes were analysed. Results: There was no significant difference in the demographics and stone diameter (13.2 ± 11.3 vs. 8.9 ± 2.8 mm) in the fL-URSL and cf-URLS group respectively. For fL-URSL, the conversion rate to cf-URSL was low (1/30) and there was a significant reduction in radiation dosage (5.4 ± 6.1 to 0.1 ± 0.7 mGy; p = 0.00), and fluoroscopy usage (40.3 ± 43.1 to 0.9 ± 4.9 seconds; p = 0.00). Perioperative complication rate (p = 0.73), the need of stents (p = 0.19), endoscopic clearance rate (p = 0.48), stone-free rate (85.7% vs. 75.0%; p = 0.31), and operative time (p = 0.94) did not differ significantly. Conclusion: Fluoroless URSL is safe and feasible. It should be routinely considered in patients with uncomplicated anatomy.