Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

doi:10.1016/j.ajur.2019.07.003

Asian Journal of Urology, 2020, 7 (3): 309-317 doi: 10.1016/j.ajur.2019.07.003

Original Article

Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers

Sarwar Noori Mahmood^a,*(

),Hewa Toffeq^b,Saman Fakhralddin^b

^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 words： Renal 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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Cite this article:

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

The demographic data of patients and stone characteristics.

Stone-free rate according to the stone size.

Incidence of complication according to the stone size.

Perioperative outcomes.

Univariate logistic regression analysis for SFR and complication.

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