EAU 2018: Fluoroless Ureteroscopy For Definitive Management Of Distal Ureteral Calculi: Randomized Controlled Trial
The authors prospectively recruited and analyzed 160 patients between May 2013 and August 2015. Of their patient cohort, 80 were randomly allocated to fluoroless ureteroscopy and 80 were allocated to standard ureteroscopy. Patients in the fluoroless group underwent cystourethroscopy in the lithotomy position to identify the ureteral orifices. Then a 0.035 inch sensor guidewire with hydrophilic tip was inserted in the ureteral orifice and deployed up until reaching the stone. At this point, visual and tactile cues, as well as fine movements were used to advance the wire past the stone. Afterwards a ureteral catheter was passed over the wire and the wire removed. Then a 0.038 in PTFR guidewire was inserted through the catheter and then the catheter was removed. When needed, a 6F to 10F Teflon dilator was used at the ureteral orifice. Next, stone extraction and/or disintegration follow as normal. At the conclusion of the case, an open-tip ureteral catheter was placed over the guidewire and fixed to a indwelling foley catheter for 24 hours.
The authors found no significant difference in age, gender, mean stone size, stone side, bmi, operative time, complications, stone migration, hematuria, or stone-free status between the fluoroless-ureteroscopy and standard ureteroscopy group. However, there was a significant difference in total fluoroscopy time and 6 of the 80 fluoroless patients required the use of fluoroscopy during their case.
Dr. Noureldin concluded that fluoroless ureteroscopy for the management of distal ureteral calculi is a safe, effective technique. However, fluoroscopy should always be available during cases for precaution.
This poster was presented as part of the stone treatment Expert-Guided Poster tour at the EAU Congress.
Speaker: Y. Noureldin
Authors: Noureldin Y., Mohey A., Alhefnawy M., Mahmoud M., Gomaa R., Soliman T., Ahmed S.
Written by: Renai Yoon, Department of Urology, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark