We aimed to study the effect of flexible ureteroscopy (FURS) for renal stones using a flexible and navigable suction ureteral access sheath (FANS) on intraoperative radiation dose and time.
This was a multicenter study of adults who underwent FURS with FANS. The correlation analysis was done to identify factors affecting radiation dose and time measured by the C-arm fluoroscopy intraoperatively.
We analyzed 110 patients, with a median age of 50 years. Of them, 72% were pre-stented prior to the procedure. The median stone volume was 1503 mm3 and the median operative time was 39 min. The median radiation dose was 7.4 mSv and median radiation time was 0.6 min. Totally, 91% of patients achieved stone-free status (Grade A or B) on the non-contrast CT scan within 30 days postoperatively. There were no cases of postoperative sepsis. Body mass index, stone volume, and total operation time were associated with a higher radiation dose. Procedures performed under general anesthesia had a lower radiation dose and time than those performed under spinal anesthesia. Disposable scopes were associated with higher radiation time than reusable scopes but not dose. A low-power holmium laser had longer radiation time than other laser sources, but only the thulium fiber laser was associated with a significantly lower radiation dose.
Our study is the first to highlight the multitude of factors affecting radiation exposure in FURS with FANS. Although not a direct measure of surgeons' actual exposure, it has important implications for the As Low As Reasonably Achievable principle which is commonly used to minimize radiation exposure to patients and operating room staff.
Asian journal of urology. 2025 Apr 03 [Epub]
Vineet Gauhar, Olivier Traxer, Thomas R W Herrmann, Daniele Castellani, Hatem Kamkoum, Wissam Kamal, Tzevat Tefik, Heng Chin Tiong, Mehmet Ilker Gökce, Michael Y C Wong, Khi Yung Fong, Ben Hall Chew, Manoj Monga, Vincent de Connick, Bhaskar Kumar Somani, Steffi Kar Kei Yuen
Department of Urology, Ng Teng Fong General Hospital, Singapore., Department of Urology, Sorbonne University, AP-HP, Hôpital Tenon, Paris, France., Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy., Department of Urology, Aisha bint Hamad al-Attiyah Hospital, Hamad, Qatar., Department of Urology and Endourology, King Fahd General Hospital, Jeddah, Saudi Arabia., Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Republic of Tu¨rkiye., Department of Urology, Ankara University, Ankara, Republic of Tu¨rkiye., Mount Elizabeth Hospital, Singapore., Department of Surgery, Singapore General Hospital, Singapore., Department of Urology, University of British Columbia, Vancouver, Canada., Department of Urology, University of California, San Diego, CA, USA., Department of Urology, AZ Klina, Brasschaat, Belgium., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom., SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.