title: Is fluoroscopic imaging mandatory for endoscopic treatment of ureteral stones?
abstract: OBJECTIVE
  To present the feasibility and safety of fluoro-less endoscopic treatment of ureteral stones to diminish radiation exposure of the patient and operating team, and to determine circumstances where a fluoroscopic imaging is mandatory.
  
  
  METHODS
  Between 2010 and 2011, 93 patients with ureteral calculi who underwent ureteroscopic treatment by experienced urologists were retrospectively evaluated. Manipulations, such as guidewire, ureteral stent insertion, and balloon dilatation were performed with visual and tactile cues. Patient demographics, need for fluoroscopic imaging, operation and fluoroscopy time, and complication and success rates were investigated.
  
  
  RESULTS
  The mean age of patients was 34.03 ± 12.09 years (range, 9-63 years). The mean stone size was 10.64 ± 3.16 mm (range, 6-17 mm). The stones were localized in the proximal, middle, and distal segments in 11, 30, and 52 patients, respectively. The mean duration of the operation was 34.51 ± 7.94 minutes (range, 24-55 minutes). Stone-free status was achieved for 90 patients (96.77%). Fluoroscopic imaging was required for 7 patients with a mean fluoroscopy time of 9 ± 4.72 seconds (range, 4-16 seconds) for the following reasons: stone migration to the kidney (3 patients), double collecting system with 2 ureters (1 patient), and ureteral orifice stricture extending to the upper segment (1 patient). No major complications were observed, but minor complications were observed in 11 patients (11.8%).
  
  
  CONCLUSIONS
  The ureteroscopic treatment of ureteral stones can be safely and effectively performed in experienced hands, with limited or no usage of fluoroscopy except in special circumstances, such as anatomic abnormalities, upper ureteral strictures, and impacted ureteral stones leading to ureteral tortuosity, kinking, and obstruction.
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armagan
authors.forename: Tolga
authors.initials: T
authors.lastname: Akman
authors.forename: Mesrur Selçuk
authors.initials: MS
authors.lastname: Sılay
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Akçay
authors.forename: Ismail
authors.initials: I
authors.lastname: Başıbüyük
authors.forename: Mehmet Remzi
authors.initials: MR
authors.lastname: Erdem
authors.forename: Şinasi Yavuz
authors.initials: ŞY
authors.lastname: Önol
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D037141:Mandatory Programs; D008875:Middle Aged; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000000981:diagnostic imaging* / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*; D055815:Young Adult