Fluoroless ureteroscopy: zero-dose fluoroscopy during ureteroscopic treatment of urinary-tract calculi
Ryan S Hsi1, Jonathan D Harper
1Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
Purpose:
Fluoroscopy usage during endoscopic procedures exposes the patient and operating room staff to ionizing radiation. Pooled mean fluoroscopy usage time during ureteroscopy reported from recent literature is 144 seconds per case. The purpose of this study was to evaluate radiation exposure using a minimal-use fluoroscopy protocol during ureteroscopic treatment of urinary-tract calculi and determine patient and perioperative factors associated with increased fluoroscopy time.
Materials And Methods:
A protocol was developed to access the ureter with the ureteroscope without fluoroscopy usage, and minimize radiation utilization during each portion of the case. Over a 16-month period, fluoroscopy usage and radiation dose for all cases involving retrograde ureteroscopy for a single surgeon were prospectively recorded. A chart review was performed on patient factors and intraoperative events.
Results:
In 162 consecutive ureteroscopic procedures for nephrolithiasis, there were 156 renal units with fluoroscopic usage data, of which total mean and median fluoroscopy time, including stent placement, was 3.3 and 2.0 seconds (0-35 seconds), respectively. Excluding fluoroscopy usage to confirm ureteral stent placement, 75% of all cases did not require any fluoroscopy time (fluoroless), and 85% required 2 seconds or less. Of the 98 renal units with radiation dosage data, the total mean and median radiation dose measured as air kerma was estimated at 1.1 and 0.6 mGy (0.0-17.5 mGy), respectively. Reasons for utilization of total fluoroscopy time more than 5 seconds included stone impaction, ureteral tortuosity or narrowing, collecting system aberrant anatomy, and difficult ureteral stent placement.
Conclusions:
The reduced fluoroscopy protocol resulted in minimal fluoroscopy time and radiation exposure, significantly lower than reported in the literature. Fluoroless ureteroscopy is safe and feasible in the majority of ureteroscopic cases and lessens exposure to patients and staff.
Insights
A new minimal-fluoroscopy protocol significantly reduced radiation exposure during ureteroscopy for kidney stones. This fluoroless approach is safe and feasible for most cases, benefiting both patients and medical staff.
Area of Science:
- Urology
- Medical Imaging
- Radiation Safety
Background:
- Fluoroscopy use in ureteroscopy exposes patients and staff to ionizing radiation.
- Previous studies report a mean fluoroscopy time of 144 seconds per case.
Purpose of the Study:
- Evaluate radiation exposure with a minimal-use fluoroscopy protocol during ureteroscopic treatment of urinary calculi.
- Identify patient and perioperative factors influencing fluoroscopy time.
Main Methods:
- Developed a protocol to minimize fluoroscopy during ureteroscope insertion and throughout the procedure.
- Prospectively recorded fluoroscopy usage and radiation dose over 16 months for retrograde ureteroscopy.
- Conducted a chart review for patient factors and intraoperative events.
Main Results:
- In 162 procedures, mean fluoroscopy time was 3.3 seconds; 75% of cases were fluoroless.
- 85% of cases used 2 seconds or less of fluoroscopy.
- Mean radiation dose was 1.1 mGy; factors for longer use included stone impaction and anatomical variations.
Conclusions:
- The minimal-use fluoroscopy protocol drastically reduced radiation exposure compared to literature.
- Fluoroless ureteroscopy is safe and feasible for most cases.
- This protocol minimizes radiation exposure for patients and operating room staff.
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