[18] Fluoroscopy free JJ stent placement through ureteroscope working channel after uncomplicated ureteroscopic laser lithotripsy: A novel technique

Objective To report a technique for ureteroscopic laser lithotripsy (URSL) and retrograde placement of a JJ stent through the ureteroscope working channel without the use of a fluoroscope compared to the conventional technique. Methods Between June 2015 and December 2017, 170 patients selected for URSL for the treatment of ureteric stones and JJ-stent insertions were evaluated. Patients were divided into two groups according to the use of fluoroscopy. In Group A (100 patients), a fluoroscope was used and in Group B (70) fluoroscopic guidance was not used. In Group B, URSL was performed first and followed by JJ-stent insertion via the semi-rigid ureteroscope 8.5–11 F under direct vision without fluoroscopy. Results The stone-free rate was 96% vs 94.3% for groups A and B, respectively. This technique was successful in all the included patients: 166 retrograde JJ stentings after URSL for ureteric calculi and four cases for anuria. Patients in Group A were exposed to radiation for a mean of 26.6 s during the URSL procedure and 4.8 s for JJ stenting. Group B was exposed to a zero dose. For Group A, the stents size was 6 F for 70% of patients, 4.7 F for 15%, and 7 F for 15%. In Group B, stents of 4.7 F and lengths of 24–26 cm were used in all patients. Failure of JJ-stent insertion was 9% (nine patients) in Group A and 18.5% (13 patients) in Group B. Conclusion This study shows the feasibility and effectiveness of completely fluoroscopy free URSL and JJ stenting for treating ureteric stones.