Ureteroscopic laser lithotripsy without fluoroscopy, a randomized controlled trial

Background: Fluoroscopy has traditionally played an integral role in ureteroscopic lithotripsy in management of ureteral stones. However, with the growing awareness of the hazardous effects of radiation associated with fluoroscopy, some advocated use of fluoroless techniques. This study aims to determine the feasibility and radiation reduction in fluoroless ureteroscopic lithotripsy in ureteral stone at any level. Operative outcomes and complications are compared with conventional ureteroscopic lithotripsy with fluoroscopy. Patients and methods For this single centre, single blind, prospective randomised controlled trial, we recruited 60 patients with unilateral ureteral stones undergoing ureteroscopic lithotripsy from January 2017 to May 2018. Patients were randomly assigned to fluoroless ureteroscopic lithotripsy group or conventional ureteroscopic lithotripsy group in a 1:1 ratio using a random number generator. The primary outcomes were radiation dosage and fluoroscopy time. Secondary outcomes were endoscopic clearance rate, stone free rate, operative time and complication rate. Results Radiation exposure in fluoroless ureteroscopic lithotripsy group was significantly lower than the conventional ureteroscopic lithotripsy group from 5.50 +/- 6.14 mGy in conventional group to 0.12 +/- 0.65 mGy in fluroless group (p=.000). Fluoroscopy time was reduced from 40.3 +/- 43.1 second in conventional group to 0.9 +/- 4.9 seconds (p=.000) in fluroless group. No significant difference in surgical outcome were noticed between the two groups. Conclusions: Fluoroless ureteroscopic lithotripsy is a safe and feasible alternative to replace conventional ureteroscopic lithotripsy with fluoroscopy in management of ureteral stones with uncomplicated anatomy by experienced hands.