Abu Dhabi, United Arab Emirates (UroToday.com) This presentation outlined the potential for performing ureteroscopy for ureteric stones without using fluoroscopy. One of the drawbacks of fluoroscopic guidance during ureteroscopy is that it exposes the patient and operative personnel to radiation. This is estimated to be from 3 mSv to 10 mSv, which is equivalent to natural background radiation exposure of 1-3 years. In an effort to decrease this radiation exposure, Dr. Rajshekhar Gupta’s group explored the feasibility of ureteroscopy without fluoroscopic guidance.

The study was conducted from April 2019 – August 2019, and included 65 patients with ureteral stones. The patients received the standard workup, including a renal function test, IVU, and KUB as required. Despite attempting to perform the procedure without fluoroscopy, the equipment for fluoroscopy was in place in case the procedure required it. They recorded the factors that necessitated fluoroscopy, and a postoperative x-ray was done to document stone clearance and stent position.

In this series of patients, the mean laser time was 8.8 minutes, and the mean procedure time was 29.9 minutes. They were able to perform fluoroless ureteroscopy in 61/66 patients. In the 5 procedures that required fluoroscopy, it was necessitated by a tight ureter that needed dilatation, and a ureter kink and tortuosity due to chronic stone impaction. There was a stone free rate of 100% in this patient series, determined by postoperative x-ray. It was discussed that, since fluoroscopy is still at hand, lead aprons would still be required to be worn by operative personnel. However, this study displays the feasibility of fluoroless ureteroscopy which can potentially decrease radiation exposure to patients with ureteral stones.

Presented by: Rajshekhar Gupta, MD, Chief of Urology, Crest Hospital, Moradabad, Uttar Pradesh, India

Written by: Rajiv Karani (Department of Urology, University of California, Irvine) at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates