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Background:
Ureteroscopy is central to the surgical management of ureteral stones. Conventionally, fluoroscopy is utilized for intraoperative guidance, although there is growing effort to reduce exposure of patients and staff to ionizing radiation. We developed a radiation -free approach to ureteroscopy using ultrasound guidance for management of ureteral stones, and present the first randomized trial to study its safety and efficacy.
Methods:
We performed a single center randomized clinical trial from 2011-2013 including adult patients presenting with symptomatic ureteral stones that were <8mm in size without significant ipsilateral stone burden. Patients were randomly assigned to undergo either ultrasound or fluoroscopic guided ureteroscopy after temporizing ureteral stent placement. Intraoperative ultrasound guidance was performed using real time imaging with the transducer placed at the patient’s flank in order to visualize the collecting system of the ipsilateral kidney. We compared operative time, stone size, stone free status, and complication rate between the two groups.
Results:
Fifty patients were enrolled with 25 patients in each arm. There was no difference in terms of stone size (p=0.56), patient age (p=0.39) or patient BMI (p=0.47). The ultrasound guidance cohort showed no significant difference in stone free rate (p=.99) or complication rate (p=0.16) when compared to the control group. Operative times were no longer in the ultrasound guidance cohort.
Conclusions:
Ureteroscopy is a first line treatment for ureteral stones. Conventional ureteroscopy relies on ionizing radiation, and raises concerns about ionizing radiation exposure to patient, surgeon, and staff. In this feasibility study, we illustrate that ureteral stones may be definitively managed in a timely, effective, and safe fashion without the use of ionizing radiation in the general population using this novel technique of ultrasound guided ureteroscopy.