title: Is fluoroscopy essential for retrieval of lower ureteric stones?
abstract: BACKGROUND
  The aim of this study was to assess the efficacy of ureteroscopy for lower ureteric stones without the use of fluoroscopy.
  
  
  METHODS
  Between June 2001 and January 2005, a total of 110 patients with a mean age of 33.5 years (range 12-65) suffering from of lower ureteral calculi (below the upper margin of the sacroiliac joint) prospectively underwent ureteroscopic removal. Retrograde pyelography was avoided, and no safety guidewire was placed. Whenever required, the ureteric meatus was dilated with a ureteric balloon under direct vision. Double-J stent placement was done with the aid of ureteroscopy. A fluoroscope was kept standby. The patients had a postoperative X-ray of the kidney-ureter-bladder region to document the stone clearance.
  
  
  RESULTS
  The mean stone size was 8.7 mm (range 6-15). Complete clearance without the use of fluoroscopy was achieved in 99 patients (94.2%). Fluoroscopy was required in 6 patients (4%) for calcified stricture (n = 1), duplex system (n = 1), narrow and tortuous meatus causing difficulty in passing the 5-Fr balloon dilator (n = 3), and confirmation of spontaneous passage of the stone (n = 1). Of the 13 patients who required balloon dilatation it was successfully achieved without fluoroscopy. Double-J stenting was done due to mucosal ulceration (n = 3), polypoid reaction (n = 2), and perforation (n = 1). All these patients had correct placement of the stent, as confirmed by X-ray of the kidney-ureter-bladder region postoperatively.
  
  
  CONCLUSIONS
  To uphold the notion for radiation exposure to be as low as reasonably achievable, ureteroscopic stone retrieval can safely be done without the use of fluoroscopy in a significant number of patients.
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. mandhani@sgpgi.ac.in
authors.forename: A
authors.initials: A
authors.lastname: Mandhani
authors.forename: H
authors.initials: H
authors.lastname: Chaudhury
authors.forename: N
authors.initials: N
authors.lastname: Gupta
authors.forename: H K
authors.initials: HK
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Kapoor
authors.forename: A
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D000075202:Contraindications; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*