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Asian Journal of Urology, 2020, 7(3): 309-317    doi: 10.1016/j.ajur.2019.07.003
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Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers
Sarwar Noori Mahmooda,*(),Hewa Toffeqb,Saman Fakhralddinb
a University of Sulaimani College of Medicine, Kurdistan, Iraq
b Sulaimania General Teaching Hospital, Sulaimania, Iraq
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Abstract  

Objective: To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL) for treating renal stones.
Methods: Between May 2015 and May 2017, 135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated. Our technique involved a semi-rigid ureteroscopic assessment of the ureter, and the guidewire was left in situ to railroad the flexible ureteroscope. A holmium laser was used to fragment and dust the stones; fragments were neither grasped nor collected.
Results: The study population consisted of 135 patients including 85 males (62.96%) and 50 females (37.04%) with a mean age of 40.65 years (range: 3-70 years) were evaluated. The mean stone size was 17.23 mm (range: 8-41 mm). Complete stone-free status was achieved in 122 (90.37%) patients and clinically insignificant residual fragments (CIRF) in two (1.48%), while residual stones were still present in 11 (8.15%) patients. Postoperative complications occurred in 23 (17.4%) cases and were mostly minor, including fever in 17 (12.6%), pyelonephritis in four (3.0%), subcapsular hematoma in one (0.7%) and steinstrasse in one (0.7%). These complications were Clavien I-II, GI in 17 (12.6%) patients, GII in five (3.7%), and Clavien IIIb in one (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 min, and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis (p<0.05).
Conclusion: Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.

Key wordsRenal stone      Retrograde intrarenal surgery      Sheathless flexible ureterorenoscopy      Fluoroless retrograde intrarenal surgery     
Received: 27 November 2018      Available online: 20 July 2020
Corresponding Authors: Sarwar Noori Mahmood     E-mail: sarwarchalabi@yahoo.com
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Sarwar Noori Mahmood
Hewa Toffeq
Saman Fakhralddin
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Sarwar Noori Mahmood,Hewa Toffeq,Saman Fakhralddin. Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers[J]. Asian Journal of Urology, 2020, 7(3): 309-317.
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http://www.ajurology.com/EN/10.1016/j.ajur.2019.07.003     OR     http://www.ajurology.com/EN/Y2020/V7/I3/309