Urolithiasis DOI 10.1007/s00240-015-0760-x
ORIGINAL PAPER
Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy‑free technique achievable? Yonghan Peng · Bin Xu · Wei Zhang · Ling Li · Min Liu · Xiaofeng Gao · Yinghao Sun
Received: 12 October 2014 / Accepted: 18 February 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract The aim of this study was to present the safety and efficacy of retrograde intrarenal surgery (RIRS) procedures that minimize the intraoperative radiation exposure. The totally endoscopy-guided RIRS technique included the following steps: (a) preoperative assessment of pelvicaliceal system anatomy and stone characteristics, (b) thorough evaluation of the ureters by rigid ureteroscopy, (c) a step-wise approach of introducing the ureteral sheath, (d) gathering stones in the more accessible renal calyx before fragmenting them, and (e) a modified holmium laser technique. The RIRS procedures performed by a single surgeon between October 2012 and October 2013 in consecutive patients with renal stones were retrospectively reviewed. The mean stone size was 1.4 ± 0.4 (range 0.8–2.0) cm. The median operative time was 74.5 min. Fluoroscopy was only used in one patient who had a double collecting system with two ureters. The stone-free status was achieved in 134 (95.7 %) patients one month after surgery. Five (3.6 %) patients had minor complications, including hematuria and fever. No major intraoperative complication was observed. We believe that with appropriate preparation, RIRS without fluoroscopic guidance can be safely and efficiently performed by experienced urologists in selected patients with renal stones. Y. Peng, B. Xu and W. Zhang contributed equally to this work and should be considered as co-first authors. Y. Peng · B. Xu · W. Zhang · L. Li · M. Liu · X. Gao (*) · Y. Sun (*) Department of Urology, Changhai Hospital, The Second Military Medical University, No.168 Changhai Road, Shanghai 200433, People’s Republic of China e-mail: [email protected] Y. Sun e-mail: [email protected]
Keywords Kidney calculi · Ureteroscopy · Radiography · Lithotripsy
Introduction A longstanding principle of flexible ureteroscopy (URS) for retrograde intrarenal surgery (RIRS) is to perform the procedure under fluoroscopic guidance. Fluoroscopy is used for initial ureteral access to define the renal collecting system, aid navigation of stones, and monitor the placement of wires and stents [1, 2]. However, with the wider spread of endoscopic treatment for urinary stones in recent years, the risk of radiation exposure has become a clinical concern both on the part of the patient and the urologist. Many patients are subjected to relatively high doses of radiation during the diagnosis and treatment of urinary stones [3]. With the technological advances in recent years, more studies have reported performing ureteroscopic procedures without fluoroscopic guidance in uncomplicated cases, including ureteral access, balloon dilation and placement of double-J stents [4–6]. The aim of this study was to evaluate the safety and efficacy of RIRS without fluoroscopic guidance for the selected patients with renal stones.
Materials and methods A retrospective study was conducted in patients who received RIRS for removing renal stones by the same urologist (XFG) in our hospital between October 2012 and October 2013. Simultaneous bilateral flexible URS, simultaneous contralateral rigid URS, percutaneous nephrolithotomy (PCNL) or laparoscopic surgery, and large stones
13
Urolithiasis
(>2 cm) that may need staged procedures were excluded from this study. Informed consent was obtained in all patients. Preoperative antibiotic therapy was administered routinely. The main outcomes were assessed with regard to stone-free and complication rates. All patients underwent plain abdominal radiography on the first day after surgery, and plain abdominal radiography or ultrasonography 1 month afterwards. The stone-free status was defined as the absence of any fragments or residual fragments
ORIGINAL PAPER
Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy‑free technique achievable? Yonghan Peng · Bin Xu · Wei Zhang · Ling Li · Min Liu · Xiaofeng Gao · Yinghao Sun
Received: 12 October 2014 / Accepted: 18 February 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract The aim of this study was to present the safety and efficacy of retrograde intrarenal surgery (RIRS) procedures that minimize the intraoperative radiation exposure. The totally endoscopy-guided RIRS technique included the following steps: (a) preoperative assessment of pelvicaliceal system anatomy and stone characteristics, (b) thorough evaluation of the ureters by rigid ureteroscopy, (c) a step-wise approach of introducing the ureteral sheath, (d) gathering stones in the more accessible renal calyx before fragmenting them, and (e) a modified holmium laser technique. The RIRS procedures performed by a single surgeon between October 2012 and October 2013 in consecutive patients with renal stones were retrospectively reviewed. The mean stone size was 1.4 ± 0.4 (range 0.8–2.0) cm. The median operative time was 74.5 min. Fluoroscopy was only used in one patient who had a double collecting system with two ureters. The stone-free status was achieved in 134 (95.7 %) patients one month after surgery. Five (3.6 %) patients had minor complications, including hematuria and fever. No major intraoperative complication was observed. We believe that with appropriate preparation, RIRS without fluoroscopic guidance can be safely and efficiently performed by experienced urologists in selected patients with renal stones. Y. Peng, B. Xu and W. Zhang contributed equally to this work and should be considered as co-first authors. Y. Peng · B. Xu · W. Zhang · L. Li · M. Liu · X. Gao (*) · Y. Sun (*) Department of Urology, Changhai Hospital, The Second Military Medical University, No.168 Changhai Road, Shanghai 200433, People’s Republic of China e-mail: [email protected] Y. Sun e-mail: [email protected]
Keywords Kidney calculi · Ureteroscopy · Radiography · Lithotripsy
Introduction A longstanding principle of flexible ureteroscopy (URS) for retrograde intrarenal surgery (RIRS) is to perform the procedure under fluoroscopic guidance. Fluoroscopy is used for initial ureteral access to define the renal collecting system, aid navigation of stones, and monitor the placement of wires and stents [1, 2]. However, with the wider spread of endoscopic treatment for urinary stones in recent years, the risk of radiation exposure has become a clinical concern both on the part of the patient and the urologist. Many patients are subjected to relatively high doses of radiation during the diagnosis and treatment of urinary stones [3]. With the technological advances in recent years, more studies have reported performing ureteroscopic procedures without fluoroscopic guidance in uncomplicated cases, including ureteral access, balloon dilation and placement of double-J stents [4–6]. The aim of this study was to evaluate the safety and efficacy of RIRS without fluoroscopic guidance for the selected patients with renal stones.
Materials and methods A retrospective study was conducted in patients who received RIRS for removing renal stones by the same urologist (XFG) in our hospital between October 2012 and October 2013. Simultaneous bilateral flexible URS, simultaneous contralateral rigid URS, percutaneous nephrolithotomy (PCNL) or laparoscopic surgery, and large stones
13
Urolithiasis
(>2 cm) that may need staged procedures were excluded from this study. Informed consent was obtained in all patients. Preoperative antibiotic therapy was administered routinely. The main outcomes were assessed with regard to stone-free and complication rates. All patients underwent plain abdominal radiography on the first day after surgery, and plain abdominal radiography or ultrasonography 1 month afterwards. The stone-free status was defined as the absence of any fragments or residual fragments
