Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?

Objective

This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy.

Methods

Forty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance.

Results

The mean ages were 43 years and 45 years in Group A and Group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm³ and 14.79 (standard deviation: 4.58) mm³ in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80.0% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups.

Conclusion

Fluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologists, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.