Sheathless and fluoroscopy-free retrograde intrarenal surgery: a single center experience

M. Lakshmi Ramesh; Y. Yuvaraju; Bathalapalli Ravi Theja; Sayyed Faisal Jagirdar; Yaswanth Gaddam; Pinnamaneni Sumanth Eswar

doi:10.18203/2320-6012.ijrms20252937

Authors

M. Lakshmi Ramesh Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
Y. Yuvaraju Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
Bathalapalli Ravi Theja Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
Sayyed Faisal Jagirdar Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
Yaswanth Gaddam Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
Pinnamaneni Sumanth Eswar Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252937

Keywords:

Flexible ureteroscopy, Fluoroless, RIRS, Sheathless

Abstract

Background: This study was done to evaluate the effectiveness and safety of minimally invasive approach to treating renal stones using sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL).

Methods: A prospective study was conducted on 270 patients who underwent FURSL between January 2023 and March 2024. The procedure involved a semi-rigid ureteroscopic assessment with 6 and 8 Fr ureteroscope. A 7.5 Fr flexible URS was inserted into the PCS by side of guidewire sheathless and fluoroscopy-free, followed by the use of a holmium laser to fragment and dust stones in situ.

Results: The study population consisted of 270 patients including 170 males (62.96%) and 100 females (37.04%) with a mean age of 40.65 years (range: 3-70 years) were evaluated. The mean stone size was 17.23 mm (range: 8-41 mm). Complete stone-free status was achieved in 244 (90.37%) patients and clinically insignificant residual fragments (CIRF) in 4 (1.48%), while residual stones were still present in 22 (8.15%) patients. Postoperative complications occurred in 46 (17.4%) cases and were mostly minor, including fever in 34 (12.6%), pyelonephritis in 8 (3.0%), subcapsular hematoma in 2 (0.7%) and steinstrasse in 2 (0.7%). These complications were Clavien I-II, GI in 34 (12.6%) patients, GII in 10 (3.7%), and Clavien IIIb in 02 (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 minutes, and lasing time ≥20 minutes were significantly associated with a higher rate of complications and lower stone-free rates (p<0.05).

Conclusions: Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.

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