Safety and efficiency of retrograde intrarenal surgery without X-ray guidance
- Authors: Guliev B.G.1,2, Talyshinsky A.E.2, Agagyulov M.U.1, Andrianov А.А.1
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Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Center of Urology with robot-assisted surgery of City Mariinsky hospital
- Issue: No 6 (2023)
- Pages: 38-43
- Section: Original Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/626006
- DOI: https://doi.org/10.18565/urology.2023.6.38-43
- ID: 626006
Cite item
Open Access
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Abstract
Introduction. The main stages of flexible ureteroscopy in patients with renal stones are usually performed under X-ray guidance. Long-term exposure of ionizing radiation can have negative effects on the patients with nephrolithiasis and the operating team.
Aim. To study the results of retrograde intrarenal surgery (RIRS) without fluoroscopic guidance.
Materials and methods. The results of flexible ureteroscopy (fURS) without X-ray-guidance in 76 patients were analyzed. There were 46 (53.3%) men and 30 (46.7%) women. The average age was 50.4±14.6 years. All patients underwent laboratory tests and non-contrast-enhanced computed tomography to determine the size and density of the stone. In all cases, preoperative ureteral stenting was performed. The average stone size was 10.5±4.2 mm. First, ureteroscopy with a rigid endoscope was done to assess the ureter and determine the depth of the introducing ureteral access sheath. After removing the ureteroscope along the guidewire, a ureteral access sheath was put at this distance. An inspection of the collecting system and laser fragmentation of kidney stones were performed using a flexible ureteroscope. In 64 (84.2%) patients, a 4.7 Ch stent was put at the end of the procedure, while in the remaining 12 (15.8%) patients, a ureteral catheter was left for 1–2 days. The operation time, stone-free rate, and the number of intra- and postoperative complications were studied.
Results. All fURS were successful and performed without X-ray guidance. The average operation time was 42.5±8.0 minutes. After the first session, stone-free rate was 92.1% (70/76). In 6 (7.9%) cases, residual stones were found, which were completely removed after the second session. Intraoperative complications, namely perforation of the upper calyx by the distal end of the ureteral access sheath, were observed in 2 (2.6%) patients, which did not require any additional interventions. Postoperative complications occurred in 10 (13.2%) patients, including fever in 6 (7.9%) and hematuria in 4 (5.3%) cases. There were no serious complications, such as ureteral perforation or sepsis, and no blood transfusion was performed.
Conclusion. Flexible ureteroscopy with laser lithotripsy can be performed safely and effectively without X-ray guidance.
Full Text
About the authors
B. G. Guliev
North-Western State Medical University named after I.I. Mechnikov; Center of Urology with robot-assisted surgery of City Mariinsky hospital
Email: gulievbg@mail.ru
ORCID iD: 0000-0002-2359-6973
Ph.D., MD, professor, Head
Russian Federation, Saint Petersburg; Saint PetersburgA. E. Talyshinsky
Center of Urology with robot-assisted surgery of City Mariinsky hospital
Author for correspondence.
Email: ali-ma@mail.ru
ORCID iD: 0000-0002-3521-8937
urologist
Russian Federation, Saint PetersburgM. U. Agagyulov
North-Western State Medical University named after I.I. Mechnikov
Email: murad1311@bk.ru
ORCID iD: 0000-0001-9647-9690
Ph.D. student at the Department of Urology
Russian Federation, Saint PetersburgА. А. Andrianov
North-Western State Medical University named after I.I. Mechnikov
Email: mr.haisenberg001@gmail.com
ORCID iD: 0000-0001-6905-0581
resident at the Department of Urology
Russian Federation, Saint PetersburgReferences
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