The As Low As Reasonably Achievable (ALARA) principle aims to minimize radiation exposure for patients and staff. This study evaluates ALARA's impact on patient radiation exposure and clinical outcomes in endourological procedures.
This retrospective study analyzed 755 patients undergoing endourological procedures (percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), shock wave lithotripsy (SWL), and JJ insertion and replacement), divided into limited- versus strict-ALARA adherence groups. We assessed radiation exposure (dose area product (DAP) and fluoroscopy time (FT)) and clinical outcomes (operative time (OT), stone free rate (SFR), complications).
Significant DAP reductions were achieved with ALARA: 90.2% (PCNL), 92.9% (URS), 63.6% (SWL), 95.1% (JJ insertion), and 94.6% (JJ replacement) (all p < 0.001). FT also decreased significantly: 58.4% (PCNL), 64.7% (URS), 18.2% (SWL), 60.3% (JJ insertion), and 62.4% (JJ replacement) (all p < 0.001). In the ALARA group, median DAP values and FT were: PCNL (3440.0 mGycm2, 3 min 17 s), SWL (2620.0 mGycm2, 2 min 26 s), JJ insertion (247.0 mGycm2, 26 s), JJ replacement (199.5 mGycm2, 19 s), and URS (158.5 mGycm2, 15 s). Patient outcomes, including SFR and postoperative complications, did not differ between the ALARA and non-ALARA groups across all procedures. Operative time was shorter in the ALARA group for both PCNL (p = 0.042) and URS (p = 0.012).
To our knowledge, this is the first multi-modality analysis linking strict ALARA adherence to exposure reduction and unchanged clinical outcomes across PCNL, URS, SWL, and stenting. Prospective, randomized trials should validate these novel results.
World journal of urology. 2025 Dec 09*** epublish ***
Vincent De Coninck, Simone Ferretti, Luis Rico, Chu Ann Chai, Anil Shrestha, Vineet Gauhar, Manoj Monga, Nariman Gadzhiev, Frédéric Panthier, Xavier Mortiers, Etienne Xavier Keller, Stefan De Wachter, Nico Buls, Olivier Traxer, Michele Marchioni
Department of Urology, AZ Klina, Augustijnslei 100, Brasschaat, Belgium. ., Department of Medical Oral and Biotechnological Science, Università degli Studi "G. 'Annunzio" di Chieti and Pescara, Chieti, Italy., Department of Urology, Hospital Aleman, Buenos Aires, Argentina., Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia., European Association of Urology Section of Endourology, Arnhem, The Netherlands., Department of Urology, University of California San Diego, San Diego, CA, USA., Departement of Urology, Saint-Petersburg State University Hospital, Saint Petersburg, Russia., Department of Urology, AZ Klina, Augustijnslei 100, Brasschaat, Belgium., Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.