Avoiding radiation exposure during retrograde intrarenal surgery; a RIRSearch score for predicting longer fluoroscopy...

Area of Science:

• Urology
• Medical Imaging
• Surgical Safety

Background:

• Radiation exposure is a concern during retrograde intrarenal surgery (RIRS).
• Predicting intraoperative fluoroscopy time is crucial for minimizing radiation dose.
• Existing methods for predicting fluoroscopy duration are limited.

Purpose of the Study:

• To identify preoperative and perioperative predictors of radiation exposure during RIRS.
• To develop and validate a scoring system (RIRSearch Score) to estimate intraoperative fluoroscopy time.

Main Methods:

• Analysis of data from 753 patients undergoing RIRS for renal stones.
• Ordinal regression to identify factors associated with fluoroscopy duration.
• Development and validation of the RIRSearch Score using ROC analysis and calibration plots.

Main Results:

• Six factors independently predicted longer fluoroscopy time: no ureteral stent, low stone density, small stone burden, multiple stones, failed ureteral access sheath insertion, and large sheath use.
• The RIRSearch Score (0-15) showed excellent discriminatory ability (AUC: 0.901).
• A score ≥10 predicted >120 seconds of fluoroscopy with 87.5% sensitivity and 86.2% specificity.

Conclusions:

• The RIRSearch Score is a practical tool for anticipating prolonged radiation exposure before RIRS.
• This scoring system can help surgeons optimize fluoroscopy use and improve occupational safety.
• Implementing the RIRSearch Score may lead to reduced radiation doses in RIRS procedures.