Stone treatment in kidneys with abnormal anatomy is technically challenging due to the difficulty in stone accessibility. Single-use flexible ureteroscopy (fURS) potentially reduces morbidity while maintaining a high level of efficacy. But, during fURS guidewires placement, balloon dilatation of the ureter, ureteric access sheath (UAS) and scanning of the pelvicalyceal system expose the patient and medical team to radiation.

In a recent study published in the Asian Journal of Urology, researchers have said that under expert Urologist supervision, fluoroscopy-free single-use flexible ureteroscopy is feasible for managing pre-stented patients with kidney calculi of <15 mm with abnormal renal anatomy.
In this study, researchers aimed to evaluate the feasibility of fluoroscopy-free single-use fURS procedure in kidney stones treatment with abnormal renal anatomy.
Researchers included Forty patients with abnormal and 80 patients with normal renal anatomy. They were treated with LithoVue single-use fURS after ureteric dilatation by two different-sized semirigid ureteroscopes. The main reason for choosing the technique was to exclude any ureteric pathology, confirm safe guidewire placement, avoid balloon dilatation of the ureter, and achieve safe insertion of 12 Fr, 35/45 cm ureteric access sheath with an optical and tactile sign and without fluoroscopy image for guidance.
Key results of the study are:
Group A and B patients had a mean age of 43 and 45, respectively. The stone burden was 14.62 mm3 and 14.79 mm3 respectively.
They found no significant difference between both groups pertaining to mean operative time, hospital stay, or stone-free rate.
The stone-free rate was 93 % and less than 60 % When the stone size was between 10-15 and 15-20mm respectively.
80% of Group A and 92.5% of Group B completed the procedure without fluoroscopy.
Complication rates were comparable.
Renal anomalies cause pain, urinary stasis, and recurrent UTI. ESWL is associated with stone localization and impaired drainage, reducing SFR. During PCNL, there is an increased risk of iatrogenic injury, they added.
They said Fluoroscopy-free single-use fURS is feasible for managing pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.
As more data become available, we expect this technique to be more widely used in clinical practice, they noted.
Semirigid ureteroscopes may not be affordable for all centres, they added.
Reference:
Aboutaleb, H., Sultan, M., Zaghloul, A., Farahat, Y., Gawish, M., & Zanaty, F. (2023). Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy? Asian Journal of Urology. https://doi.org/10.1016/j.ajur.2023.05.004