Fluoroscopy-free semirigid ureteroscopy for ureteral stone treatment: A prospective single-arm study of feasibility, efficacy, and safety

Objectives: Patients with urolithiasis receive a significant amount of radiation during diagnosis, treatment, and follow-up of their pathology, with nearly 20% receiving more than the annual recommended, creating a growing concern regarding radiation exposure faced by patients and health personnel. The objectives of the study were to describe a standardized fluoroscopy-free (FF) semirigid (SR) ureteroscopy (URS) technique for ureteral stone treatment and to determine the feasibility, efficacy, and safety of this technique for the treatment of ureteral stones comparing it to a historical cohort of fluoroscopy-guided (FG) SR-URS. Materials and Methods: A prospective single-arm study of patients submitted to FF SR-URS was conducted. Visual and tactile cues were employed to avoid the use of ionizing radiation. The success (feasibility), stone-free (efficacy), and complication (safety) rates of each procedure were registered. The results were compared to a historical cohort of patients that underwent FG SR-URS at our center. Results: One hundred and five patients subjected to FF SR-URS were included in the study and compared to a historical cohort of 87 patients subjected to FG SR-URS. The main characteristics were comparable among groups. Ninety-seven patients (92.38%) were completed without any use of ionizing radiation. The stone-free rate was 92.45%, similar to the historical cohort. Only Clavien I and II complications were found without statistical difference between the study groups. The average dose of radiation exposure for the historical cohort was approximately 0.5 mSv. Conclusions: FF SR-URS is a feasible, efficacious, and safe technique for treating the ureteral stones for urologists with good practice of the traditional technique. Implementing this procedure allows a decrease in radiation exposure to both patients and health personnel.