title: Fluoroscopy free flexible ureteroscopy with holmium: Yttrium-aluminium-garnet laser lithotripsy for removal of renal calculi.
abstract: OBJECTIVE
  To evaluate the feasibility of access sheath insertion and ureteric stent placement without image guidance in flexible ureteroscopic lithotripsy with holmium:yttrium-aluminium-garnet laser for renal stones.
  
  
  METHODS
  Between March 2014 and October 2015, 80 patients with renal stones treated with flexible ureteroscopic laser lithotripsy were evaluated. Indications for surgery were renal obstruction, failed shockwave lithotripsy (SWL), stones in polycystic kidneys, and mal-rotated kidneys. A 6.5-F Cobra flexible ureteroscope was used in all cases with an access sheath of 12 F, 35/45 cm in length. Fluoroscopy was not intended for use in all cases and postoperative JJ stenting was optional. The perioperative complications were listed and the collected data were analysed.
  
  
  RESULTS
  The study included 80 patients (66 male, 14 female), with a mean (SD; range) age of 48.2 (8; 28-54) years and a stone burden of 13 (3.5; range 6-23) mm. In all, 26 patients had a stone burden of >15 mm and 48 patients had lower calyceal stones. The mean (SD; range) operative time was 71.5 (20; 25-130) min. Overall, 76 (95%) access sheath insertions were performed successfully without the use of fluoroscopy. JJ stenting was used in 22 patients (27.5%). The mean (SD; range) hospital stay was 10 (8.5; 10-36) h. After one session, a stone-free rate (SFR) of 87.5% was achieved (93.3% for stones of <15 mm). A single session was successful in 87.9% of cases with lower calyceal stones, with a SFR of 91.7% for post-SWL failure cases. The perioperative complication rate was 15%.
  
  
  CONCLUSIONS
  Access sheath insertion without fluoroscopic guidance is feasible. This technique reduces radiation exposure in patients requiring flexible ureteroscopy.
authors.affiliation: Department of Urology, Minoufiya University Hospital, Minoufiya, Egypt.
authors.forename: Hamdy
authors.initials: H
authors.lastname: Aboutaleb
keywords: Ho:YAG laser; KUB, plain abdominal radiograph of the kidneys ureters and bladder; Lithotripsy; PCNL, percutaneous nephrolithotomy; PCS, Pelvicalyceal system; Renal calculi; SFR, stone-free rate; SWL, shockwave lithotripsy; URS, ureteroscopy; URSL, ureteroscopic laser lithotripsy; US, ultrasonography/ultrasound; Ureteroscopy; YAG, yttrium-aluminium-garnet