MOHEY A, ALHEFNAWY M, MAHMOUD M,
GOMAA R, SOLIMAN T, AHMED S, NOURELDIN
YA. Fluoroless ureteroscopy for definitive
management of distal ureteral calculi: randomized
controlled trial. Can J Urol 2018;25(1):0000-0000.
Introduction: To assess the conversion rate during
fluoroless-ureteroscopy (URS) and evaluate the feasibility,
safety, and efficacy of fluoroless-URS as a definitive
management of distal ureteral calculi.
Material and methods: Between May 2013 and August
2015, patients with radio-opaque distal ureteral calculi
of ≤ 1 cm in size were randomized to undergo fluoroless-
URS or standard URS. Patients with previous ureteral
surgery, ureteral kinking, ureteral stricture, single kidney,
additional proximal ureteral or renal calculi, uncontrolled
coagulopathy, and/or congenital anomalies of the urinary
tract were excluded. Patients’ demographics, stone
characteristics, operative data, stone free status, and
complications were compared between both groups.
Results: Seventy-four cases in the fluoroless-URS
group were compared with 80 cases in the standard-URS
group. There was no significant difference in the baseline
characteristics between both groups in terms of the mean
patient’s age (28.8 ± 13.3 versus 29.5 ± 14.6 years;
p = 0.76), body mass index (28.2 ± 33 versus 27.6 ± 2.3 kg/m2;
p = 0.19), and stone size (7.2 ± 1.5 versus 7.3 ± 1.7 mm;
p = 0.70), respectively. Furthermore, there was no
significant difference in the outcome parameters between
both groups in terms of operative time (42.4 ± 8.3 versus
40.3 ± 6.5 min; p = 0.08), stone free rate (93.2% versus
95%; p = 0.06), and overall complications (12.2% versus
8.75%; p = 0.08), respectively. There was significant
difference between both techniques in terms of fluoroscopy
time (p < 0.001). However, 6 (7.5%) fluoroless-URS
cases necessitated the use of fluoroscopy intraoperatively.
Conclusion: Ureteroscopic management of distal ureteral
stones using fluoroless-URS technique could be feasible
and safe, without radiation exposure for patients and
medical personnel. However, fluoroscopy should always
be available during fluoroless-URS.