Open Access

ARTICLE

Fluoroless-ureteroscopy for definitive management of distal ureteral calculi: randomized controlled trial

Ahmed Mohey, Mohamed Alhefnawy, Mostafa Mahmoud, Rabea Gomaa, Tarek Soliman, Shabieb Ahmed, Yasser A. Noureldin

Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
Address correspondence to Dr. Yasser A. Noureldin, Department of Urology, Benha Faculty of Medicine, Benha, Kalyobiya, Egypt 13511

Canadian Journal of Urology 2018, 25(1), 9205-9209.

Abstract

Introduction: This study aims to assess the conversion rate during fluoroless ureteroscopy (URS) and evaluate its feasibility, safety, and efficacy as a definitive management approach for distal ureteral calculi.
Materials and methods: Between May 2013 and August 2015, patients with radio-opaque distal ureteral stones ≤ 1 cm in size were randomized to undergo either fluoroless-URS or standard URS. Exclusion criteria included prior ureteral surgery, ureteral kinking or stricture, single kidney, additional proximal ureteral or renal stones, uncontrolled coagulopathy, and/or congenital urinary tract anomalies. Patient demographics, stone characteristics, operative data, stone-free status, and complications were compared between the two groups.
Results: Seventy-four patients underwent fluoroless-URS and 80 underwent standard URS. There were no significant differences in baseline characteristics between the groups, including mean age (28.8 ± 13.3 vs. 29.5 ± 14.6 years; p = 0.76), body mass index (28.2 ± 3.3 vs. 27.6 ± 2.3 kg/m²; p = 0.19), and stone size (7.2 ± 1.5 vs. 7.3 ± 1.7 mm; p = 0.70). Similarly, there were no significant differences in operative time (42.4 ± 8.3 vs. 40.3 ± 6.5 min; p = 0.08), stone-free rate (93.2% vs. 95%; p = 0.06), or overall complication rates (12.2% vs. 8.75%; p = 0.08). A significant difference was observed in fluoroscopy time (p < 0.001). However, six cases (7.5%) in the fluoroless-URS group required intraoperative fluoroscopy.
Conclusion: Ureteroscopic management of distal ureteral stones using the fluoroless-URS technique is feasible and safe, with comparable outcomes to standard URS and without radiation exposure to patients or medical staff. However, fluoroscopy should remain available during fluoroless procedures to manage unexpected challenges.

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