Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature-Tips and Tricks.

Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation.

Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.

Current urology reports. 2020 May 23*** epublish ***

E Emiliani, A Kanashiro, T Chi, D A Pérez-Fentes, B O Manzo, O Angerri, B K Somani

Department of Urology, Fundacion Puigvert. Autonomous University of Barcelona, Barcelona, Spain. ., Department of Urology, Fundacion Puigvert. Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, University of California San Francisco (UCSF), San Francisco, CA, USA., Department of Urology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Department of Urology, Hospital Regional de Alta Especialidad del Bajío, Leon, Mexico., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.