Connors Christopher, Gupta Kavita, Savin Ziv, Khargi Raymond, Geffner Adam, Gallante Blair, Atallah William M, Gupta Mantu
Urology Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
World J Urol. 2025 Jul 7;43(1):414. doi: 10.1007/s00345-025-05789-w.
We sought to evaluate the safety and efficacy of an approach attempting no fluoroscopy (F), ureteral sheaths (US), or stents (S) during retrograde intrarenal surgery (NoFUSS-RIRS) and to compare it to conventional RIRS (C-RIRS).
We prospectively collected data on the first 75 NoFUSS-RIRS procedures in patients with 5-20 mm renal stones and compared them to a cohort of 75 prior patients undergoing C-RIRS which involved fluoroscopy and stent placement. Baseline characteristics, safety outcomes (including Clavien-Dindo complications, ED visits, and readmissions), and CT-determined stone-free rates were compared. Secondary outcomes included the incidence of fluoroscopy and stent utilization.
The NoFUSS protocol was successfully implemented in over 90% of patients, with no cases requiring fluoroscopy or ureteral sheaths and only 9.3% requiring a stent. There were no significant differences in baseline or stone characteristics between groups. Median operating room time was significantly shorter in the NoFUSS-RIRS group (46 vs. 64 min, p < 0.001). There were no differences in complications (6.7% vs. 6.7%), ED visits (5.3% vs. 5.3%), or readmissions (2.7% vs. 2.7%) between NoFUSS-RIRS and C-RIRS groups, all p = 1. There were no significant differences in CT-based stone-free rates across all residual fragment (RF) categories including zero RF (NoFUSS-RIRS: 82.7% vs. C-RIRS: 72.7%, p = 0.199), RF < 3 mm, and RF ≥ 3 mm.
A NoFUSS-RIRS protocol offers similar stone-free rates compared to C-RIRS with no increase in safety-related outcomes. Moreover, operative costs and radiation exposure to patients and operating room staff can be significantly reduced.
我们旨在评估逆行性肾内手术（无荧光透视、输尿管鞘及支架的逆行性肾内手术，NoFUSS-RIRS）中不使用荧光透视（F）、输尿管鞘（US）或支架（S）这种方法的安全性和有效性，并将其与传统逆行性肾内手术（C-RIRS）进行比较。
我们前瞻性收集了75例5-20毫米肾结石患者首次接受NoFUSS-RIRS手术的数据，并将其与75例先前接受C-RIRS手术（包括荧光透视和支架置入）的患者队列进行比较。比较了基线特征、安全性结果（包括Clavien-Dindo并发症、急诊就诊和再入院情况）以及CT确定的结石清除率。次要结果包括荧光透视和支架使用的发生率。
超过90%的患者成功实施了NoFUSS方案，无病例需要荧光透视或输尿管鞘，仅9.3%的患者需要支架。两组之间的基线或结石特征无显著差异。NoFUSS-RIRS组的中位手术时间明显更短（46分钟对6分钟，p<0.001）。NoFUSS-RIRS组和C-RIRS组在并发症（6.7%对6.7%）、急诊就诊（5.3%对5.3%）或再入院（2.7%对2.7%）方面无差异，p均=1。在所有残余碎片（RF）类别中，包括零RF（NoFUSS-RIRS：82.7%对C-RIRS：72.7%，p=0.199）、RF<3毫米和RF≥3毫米，基于CT的结石清除率无显著差异。
与C-RIRS相比，NoFUSS-RIRS方案的结石清除率相似，且与安全相关的结果没有增加。此外，可显著降低手术成本以及患者和手术室工作人员的辐射暴露。
