Bozkurt Muammer, Seker Kamil Gokhan
Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Urology, Mus State Hospital, Mus, Turkey.
Urologia. 2023 Feb;90(1):130-135. doi: 10.1177/03915603221114459. Epub 2022 Sep 1.
Fluoroscopy is used in some stages of the conventional Retrograde Intrarenal Surgery (RIRS) procedure and is beneficial. On the other hand, radiation exposure is its most obvious disadvantage. As a subgroup, we aimed to show that fluoroscopy-free technique is safe and effective in patients who underwent RIRS after passive dilatation.
Between October 2018 and April 2020, 54 cases of second session RIRS of renal stones performed by a single surgeon were retrospectively evaluated. Patients' demographic characteristics (age, gender), stone features (laterality, size, number, volume, and location), mean operative time, and, perioperative and postoperative complications, as well as the stone-free rate (SFR), were all retrospectively evaluated. The results were classified as stone free, clinical insignificant residual fragments (CIRF), and presence of residual stones. Complications were graded using the Clavien-Dindo classification system. We used a modified surgical technique.
All of complications were minor. There were no major complications (Clavien grade III-IV). The stone-free rate was 70.3% (38/54) on the first day after surgery and 83.3% (45/54) 1 month afterward, respectively. If we accept the absence of residual stone as success, we can say that it is about 91% successful in the first month.
This technique has a high stone-free success rate and a low complication rate without the use of radiation. For surgeons experienced in endourology, we can say that the fluoroscopy-free technique is safe and effective in secondary-session RIRS cases which passive dilatation was performed by inserting a ureteral catheter before.
在传统逆行性肾内手术（RIRS）的某些阶段会使用荧光透视检查，它是有益的。另一方面，辐射暴露是其最明显的缺点。作为一个亚组，我们旨在表明，对于在被动扩张后接受RIRS的患者，无荧光透视检查技术是安全有效的。
回顾性评估2018年10月至2020年4月间由单一外科医生进行的54例肾结石二期RIRS病例。回顾性评估患者的人口统计学特征（年龄、性别）、结石特征（侧别、大小、数量、体积和位置）、平均手术时间、围手术期和术后并发症以及无结石率（SFR）。结果分为无结石、临床意义不显著的残留碎片（CIRF）和残留结石的存在。并发症采用Clavien-Dindo分类系统分级。我们采用了改良的手术技术。
所有并发症均为轻微。无严重并发症（Clavien III-IV级）。术后第一天的无结石率分别为70.3%（38/54），术后1个月为83.3%（45/54）。如果我们将无残留结石视为成功，那么可以说在第一个月的成功率约为91%。
该技术在不使用辐射的情况下具有较高的无结石成功率和较低并发症发生率。对于有腔内泌尿外科经验的外科医生而言，可以说无荧光透视检查技术在之前通过插入输尿管导管进行被动扩张的二期RIRS病例中是安全有效的。
