Kidney stone surgery without radiation safe when performed by experienced urologists

This study, "Comparison of Treatment Outcomes for Fluoroscopic and Fluoroscopy-free Endourological Procedures: A Systematic Review on Behalf of the European Association of Urology Urolithiasis Guidelines Panel", is researched by Davis et al. and colleagues.

Endourological procedures require fluoroscopic guidance. This causes harmful radiation exposure to patients and staff. One clinician-controlled method to decrease this exposure in urolithiasis patients is to avoid using intraoperative fluoroscopy during stone intervention procedures.

Considering this background, researchers assessed the benefits and risks of "fluoroscopy-free" and fluoroscopic endourological interventions in such patients by performing systematic reviews using databases like MEDLINE/PubMed, Embase, and Cochrane.

SFR and complications were the primary outcomes, while secondary were:

• Operative duration.
• Hospital length of stay.
• Conversion from a fluoroscopy-free to a fluoroscopic procedure.
• Additional procedure requirement.

The key results of the study are:

• A total of 24 studies were eligible for analysis.
• A total of 4564 patients were with urolithiasis.
• 2309 underwent a fluoroscopy-free procedure.
• 2255 underwent a comparative fluoroscopic procedure for managing urolithiasis.
• There was no reported difference between the groups in SFR, operative duration or LOS.
• The fluoroscopy group had higher rates of complications.
• The incidence of conversion from a fluoroscopy-free to a fluoroscopic procedure was 2.84%.
• They observed similarities in results in subanalyses for ureteroscopy and PCNL.
• Analysing only randomised studies, the fluoroscopy group's overall complication rate was significant.

In this study, researchers compared treatments for kidney stones with/ without radiation use.

Conclusion Further, fluoroscopy-free and fluoroscopic endourological procedures have comparable stone-free and complication rates under the supervision of experienced urologists.

Based on the findings of our study, we found a low conversion rate from a fluoroscopy-free to a fluoroscopic endourological procedure, they wrote.

One of the essential highlights of this study is that the investigative findings are important from the perspective of both patients because the detrimental health effects of ionising radiation are preventable/avoidable during surgery for kidney stones.

Further reading:

https://www.sciencedirect.com/science/article/abs/pii/S2405456923001190