Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
JU INSIGHT The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery
By: Jae-Wook Chung, MD, PhD, School of Medicine, Kyungpook National University, Daegu, South Korea, Chilgok Kyungpook National University Hospital, Daegu, South Korea; Jun-Koo Kang, MD, MS, Kyungpook National University Hospital, Daegu, South Korea; Wonho Jung, MD, MS, Keimyung University School of Medicine, Dongsan Hospital, Daegu, South Korea; Kyung Jin Oh, MD, PhD, Chonnam National University Medical School, Gwangju, South Korea; Hyeon Woo Kim, MD, PhD, Pusan National University School of Medicine, Busan, South Korea; Dong Gil Shin, MD, PhD, Pusan National University School of Medicine, Busan, South Korea; Bum Soo Kim, MD, PhD, School of Medicine, Kyungpook National University, Daegu, South Korea, Kyungpook National University Hospital, Daegu, South Korea | Posted on: 18 Jun 2024
Chung JW, Kang JK, Jung W, et al. The efficacy and safety of radiation-free retrograde intrarenal surgery: a prospective multicenter-based, randomized, controlled trial. J Urol. 2024;211(6):735-742. doi:10.1097/JU.0000000000003920
Study Need and Importance
Fluoroscopy is usually required during retrograde intrarenal surgery (RIRS). Although fluoroscopy is considered necessary for effective and safe RIRS, there is growing awareness regarding radiation exposure risk to patients and surgeons. However, there are no prospective, multicenter-based, randomized, controlled trials comparing the success rates or safety between radiation-usage (RU) and radiation-free (RF) RIRS.
What We Found
Of the 140 consecutive randomized participants, 128 patients completed this study (RF: 63; RU: 65). The success rate (78% vs 80%, P = .8) were not significantly different between the RF and RU groups. The rate of high-grade (grade 2-4) ureter injury was not significantly higher in the RF group compared to the RU group (4.8% vs 3.1%; Table). In RF RIRS, the success rate was noninferior compared to RU RIRS (the difference was 2.2% [95% CI, 0.16-0.12]).
Table. Postoperative Outcomes Between Radiation-Free and Radiation-Usage Groups
| Radiation-free group (n = 63) | Radiation-usage group (n = 65) | P value | |
|---|---|---|---|
| Success, No. (%) | 49 (78) | 52 (80) | .8 |
| Ureter injury, No. (%), grade | .7 | ||
| 0 | 53 (84) | 54 (83) | |
| 1 | 7 (11) | 9 (14) | |
| 2 | 2 (3.2) | 2 (3.1) | |
| 3 | 1 (1.6) | 0 (0) | |
| High-grade ureter injury, No. (%) | 3 (4.8) | 2 (3.1) | .6 |
Limitations
Limitations of the study include a relatively small cohort, the absence of long-term complication data, and variations in the types of rigid ureteroscopes, ureteral access sheaths, and flexible ureterorenoscopes. Most participants had a single uncomplicated stone, making RF RIRS manageable for experienced urologists.
Interpretation for Patient Care
The success rate of RF RIRS was not inferior, and the rate of high-grade ureteral injury was not significantly different compared to RU RIRS. This study demonstrated that RF RIRS can be effectively and safely performed in uncomplicated cases of renal stones.
advertisement
advertisement