Ultrasound versus fluoroscopy-guided ureteroscopy for distal ureteric stones in adults

To evaluate the safety and efficacy of ultrasound (US) as alternative to fluoroscopy for guidance of ureteroscopy (URS) during treatment of distal ureteric stones in adults.

This study enrolled 80 patients older than 18 years presented with a single distal ureteric radio-opaque stone of ≤15 mm in longest diameter. Patients were randomized and allocated into two groups: the fluoroscopy group and the ultrasound group (n = 40 patients in each group). Patients with bilateral ureteric stones, solitary kidney, ureteric congenital anomalies, history of failed ureteroscopy, history of ureteric surgery, patients with uremia and pregnant women were excluded. Patients' demographics, stone characteristics, operative data, stone-free status, hospital stay and complications were evaluated in both groups.

No statistically significant difference between both groups was found regarding patients' demographics and stone characteristics. Also there was no statistically significant difference in comparing fluoroscopy group versus ultrasound group regarding operative time (29.48 ± 15.3 versus 31.28 ± 18.24 min; P = 0.83), stone-free rate (97.5% versus 95%; P = 1.0), overall complications (15% versus 12.5%; P = 0.75), or hospital stay (1.17 ± 0.6 versus 1.02 ± 0.16 days; P = 0.12). Four patients (10%) in the ultrasound group required the addition of fluoroscopy beside ultrasound.

Ultrasound is effective in guidance during ureteroscopy for distal ureteric stones. It was comparable to fluoroscopy in terms of stone free rate, operative time, overall complications, and hospital stay. However, fluoroscopy must be available to be used when needed.