• Logo
  • SBMUJournals

Comparison of Two Different Retrograde Intrarenal Surgical Techniques: Is It Mandatory to Use Fluoroscopy During Retrograde Intrarenal Surgery?

Ergun Alma, Hakan Ercil



Purpose: To evaluate the efficacy and reliability of fluoroscopy-free retrograde intrarenal surgery.

Materials and Methods: A retrospective evaluation was made of the data of 226 patients who underwent RIRS as kidney stone treatment between May 2015 and May 2017. When evaluation was made acccording to the exclusion criteria, the study continued with a total of 190 patients including 103 in whom fluoroscopy was used (Group 1) and 87 who underwent a fluoroscopy-free procedure (Group 2).

Result: Group 1 patients comprised of 56 males and 47 females with a mean age of 41.5 ± 13.9 years. Group 2 patients comprised of 48 males and 39 females with a mean age of 42.6 ± 15.2 years. The mean stone size was 14.3 ± 2.7 mm in Group 1 and 14.1 ± 2.8 mm in Group 2. The mean operating time was calculated as 63.6 ± 8.2 minutes in Group 1 and 65.7 ± 9.7 minutes in Group 2. In Group 1, the success rate was determined as 83.5% on postoperative day 1 and as 92.2% in the postoperative first month. In Group 2, these rates were 81.6% and 90.8% respectively. No statistically significant difference was determined between the groups in respect of stone size (P= .752), operating time (P = .108) and postoperative first day (P = .732) and first month success rates (P = .724).

Conclusion: Fluoroscopy-free RIRS is a surgical technique with a high rate of success that can be applied safely to be able to protect patients at high risk of radiation and the surgical team, particularly in centers with high patient circulation..


Resorlu B, Oguz U, Resorlu EB, Oztuna D, Unsal A. The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology 2012;79:61-6.

Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater--is this the new frontier? J Urol 2008;179:981-4.

Resorlu B, Unsal A, Ziypak T, Diri A, Atis A, Guven S et al. Comparison of retrograde intrarenal surgery, shock wave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 2013;31:1581-6.

Liu SZ. Biological effects of low level exposures to ionizing radiation: theory and practice. Hum Exp Toxicol 2010;29:275-81.

Tang J, Huang Y, Nguyen DH, Costes SV, Snijders AM, Mao JH. Genetic Background Modulates lnc RNA-Coordinated Tissue Response to Low Dose Ionizing Radiation. Int J Genomics DOI: 10.1155/2015/461038.

Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int 2014;92:164-8.

Olgin G, Smith D, Alsyouf M, Arenas J, Engebretsen S, Huang G et al. Ureteroscopy Without Fluoroscopy: A Feasibility Study and Comparison with Conventional Ureteroscopy. J Endourol 2015;29:625-9.

Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 2000;154:178-86.

Mountford PJ, Temperton DH. Recommendations of the International Commission on Radiological Protection (IRCP) 1990. Eur J Nucl Med 1992;19:77-9.

Hanel DP, Robson DB. The image intensifier as an operating table. J Hand Surg Am 1987;12:322–3.

Levin PE, Schoen Jr RW, Browner BD. Radiation exposure to the surgeon during closed interlocking intramedullary nailing. J Bone Joint Surg Am 1987;69:761–6.

Hoffler CE, Ilyas AM. Fluoroscopic radiation exposure: are we protecting ourselves adequately? J Bone Joint Surg Am 2015;97:721-5.

Greene DJ, Tenggadjaja CF, Bowman RJ, Agarwal G, Ebrahimi KY, Baldwin DD. Comparison of a reduced radiation fluoroscopy protocol to conventional fluoroscopy during uncomplicated ureteroscopy. Urology 2011;78:286-90.

Kirac M, Tepeler A, Guneri C, Kalkan S, Kardas S,Armagan A, Biri H. Reduced radiation fluoroscopy protocol during retrograde intrarenal surgery for the treatment of kidney stones. Urol J 2014;11:1589-94.

Peng Y, Xu B, Zhang W, Li L, Liu M, Gao X et al. Retrograde intrarenal surgery for the treatment of renalstones: is fluoroscopy-free technique achievable? Urolithiasis 2015;43:265-70.

Graversen JA, Valderrama OM, Korets R, Mues AC, Landman J, Badani KK et al. The effect of extralumenal safety wires on ureteral injury and insertion force of ureteral access sheaths: evaluation using an ex vivo porcine model. Urology 2012;79:1011-4.

Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol 1998;159:1139–43.

Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology 1996;48:199–206.

Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009;55:1190-6.

Torricelli FC, De S, Hinck B, Noble M, Monga M. Flexible ureteroscopy with a ureteral access sheath: when to stent? Urology 2014;83:278-81.

DOI: http://dx.doi.org/10.22037/uj.v0i0.4382


  • There are currently no refbacks.