Evaluation of a fluoroscopy-free, ureteral access sheath-free, and stent-free approach to retrograde intrarenal surgery.

PURPOSE: We sought to evaluate the safety and efficacy of an approach attempting no fluoroscopy (F), ureteral sheaths (US), or stents (S) during retrograde intrarenal surgery (NoFUSS-RIRS) and to compare it to conventional RIRS (C-RIRS).

METHODS

We prospectively collected data on the first 75 NoFUSS-RIRS procedures in patients with 5-20 mm renal stones and compared them to a cohort of 75 prior patients undergoing C-RIRS which involved fluoroscopy and stent placement. Baseline characteristics, safety outcomes (including Clavien-Dindo complications, ED visits, and readmissions), and CT-determined stone-free rates were compared. Secondary outcomes included the incidence of fluoroscopy and stent utilization.

RESULTS

The NoFUSS protocol was successfully implemented in over 90% of patients, with no cases requiring fluoroscopy or ureteral sheaths and only 9.3% requiring a stent. There were no significant differences in baseline or stone characteristics between groups. Median operating room time was significantly shorter in the NoFUSS-RIRS group (46 vs. 64 min, p < 0.001). There were no differences in complications (6.7% vs. 6.7%), ED visits (5.3% vs. 5.3%), or readmissions (2.7% vs. 2.7%) between NoFUSS-RIRS and C-RIRS groups, all p = 1. There were no significant differences in CT-based stone-free rates across all residual fragment (RF) categories including zero RF (NoFUSS-RIRS: 82.7% vs. C-RIRS: 72.7%, p = 0.199), RF < 3 mm, and RF ≥ 3 mm.

CONCLUSIONS

A NoFUSS-RIRS protocol offers similar stone-free rates compared to C-RIRS with no increase in safety-related outcomes. Moreover, operative costs and radiation exposure to patients and operating room staff can be significantly reduced.