İrfan ORHAN, Necip PİRİNÇÇİ, Tunç OZAN, Fatih FIRDOLAŞ, Ahmet KARAKEÇİ

Retrograde intrarenal surgery technique without using fluoroscopy and access sheet in the treatment of kidney stones

Background/aim: In this study, we aimed to present our results on single-guidewire flexible ureteroscopy and retrograde intrarenalsurgery without fluoroscopy and an access sheet, and to evaluate the efficacy and safety of this procedure retrospectively.Material and methods: Our routine technique can be described as the evaluation of the ureter using a semirigid ureterorenoscope(URS), leading in the guidewire through the semirigid URS, pulling the semirigid URS back, inserting the flexible URS with the aid ofthe guidewire, inserting the laser probe through the flexible URS, and performing laser lithotripsy.Results: Our study included 400 male and 198 female patients with a mean age of 36.8 ± 16 (14–80) years. The mean stone size was 8.7± 4 (8–20) mm, and the mean operation time was 56 (32–106) min. Postoperative fever was observed in 24 (4%) of the patients, and 30(5%) patients had hematuria as a minor complication. A stone-free status was observed in 466 (78%) patients, while 102 (17%) patientshad clinically insignificant minor stone fragments and 30 patients had clinically significant stone residue.Conclusion: The retrograde intrarenal surgery procedure using only a guidewire without fluoroscopy and an access sheet in thetreatment of kidney stones is technically safe and effective.

PDF

___

1. Alan C, Koçoğlu H, Ersay AR. Retrograd intrarenal cerrahi; uygulama tekniği, klinik sonuçlar ve ipuçları. Yeni Üroloji Dergisi 2011; 6: 32-41 (in Turkish).
2. Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011; 39: 185-188.
3. Smith RD, Patel A. Impact of flexible ureterorenoscopy in current management of nephrolithiasis. Curr Opin Urol 2007; 17: 114-119.
4. Belko DT, Denstedt JD. Advances in ureterorenoscopy. Urol Clin North Am 2007; 34: 397-408.
5. Shah DJ, Sachs RK, Wilson DJ. Radiation-induced cancer: a modern view. Br J Radiol 2012; 85: 1166-1173.
6. Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363: 345-351.
7. Rassweiler JJ, Renner C, Eisenberger F. The management of complex stones. BJU Int 2000; 86: 919-928.
8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205- 213.
9. Tefekli A, Tok A, Altunrende F, Barut M, Berberoglu Y, Müslümanoğlu AY. Üriner sistem taş hastalarında yaşam tarzı ve beslenme alışkanlıkları. Türk Üroloji Dergisi 2005; 31: 113- 118 (in Turkish).
10. Huffman JL, Bagley DH, Lyon ES. Extending cystoscopic techniques into the ureter and renal pelvis. Experience with ureteroscopy and pyeloscopy. JAMA 1983; 250: 2002-2005.
11. Akpınar H, Tüfek İ, Gürtuğ A, Kural AR. Üst üriner sistem hastalıklarının tanı ve tedavisinde fleksibl üreteroskopi. Türk Üroloji Dergisi 2003; 29: 454-459 (in Turkish).
12. Reşorlu B, Ünsal A. Böbrek taşlarının tedavisinde retrograd intrarenal cerrahi (RIRC). Türk Üroloji Seminerleri 2011; 2: 64-67 (in Turkish).
13. Mahesh M. Fluoroscopy: patient radiation exposure issues. Radiographics 2001; 21: 1033-1045.
14. Geavlete P, Multescu R, Geavlete B. Health policy: reducing radiation exposure time for ureteroscopic procedures. Nat Rev Urol 2011; 8: 478-479.
15. Hellawell GO, Mutch SJ, Thevendran G, Wells E, Morgan RJ. Radiation exposure and the urologist: what are the risks? J Urol 2005; 174: 948-952.
16. Mandhani A, Chaudhury H, Gupta N, Singh HK, Kapoor R, Kumar A. Is fluoroscopy essential for retrieval of low ureteric stones? Urol Int 2007; 78: 70-72.
17. Tepeler A, Armagan A, Akman T, Silay MS, Akcay M, Başıbüyük I, Erdem MR, Önol ŞY. Is fluoroscopic imaging mandatory for endoscopic treatment of ureteral stones? Urology 2012; 80: 1002-1006.
18. Çimen Hİ, Halis F, Sağlam HS, Gökçe A. Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones. Turk J Urol 2017; 43: 309-312.
19. 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: 1589-1594.
20. Al-Qahtani SM, Letendre J, Thomas A, Natalin R, Saussez T, Traxer O. Which ureteral access sheath is compatible with your flexible ureteroscope? J Endourol 2014; 28: 286-290.
21. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013; 189: 580-584.
22. Oguz U, Balci M, Atis G, Bozkurt OF, Tuncel A, Halis F, Aslan Y, Yildirim IO, Senocak C, Yordam M et al. Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation. Urolithiasis 2014; 42: 141-147.
23. Peng Y, Xu B, Zhang W, Li L, Liu M, Gao X, Sun Y. Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy-free technique achievable? Urolithiasis 2015; 43: 265-270.
24. Ray AA, Ghiculete D, Pace KT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology 2010; 76: 295-300.
25. Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol 2002; 41: 351-362.
26. Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a metaanalyses. AJR Am J Roentgenol 2008; 191: 396-401.