Session: MP35: Stone Disease: Surgical Therapy (including ESWL) II
MP35-20: Comparing treatment outcomes for fluoroscopic and 'fluoroscopy-free' endourological procedures: A systematic review on behalf of the EAU urolithiasis guidelines panel
Introduction: Endourological procedures frequently necessitate fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. Recently, several reports underlined the possibility to bypass the use of fluoroscopy. The aim of this systematic review and meta-analysis is to compare benefits and risks of fluoroscopic vs fluoroscopy-free procedures. Methods: A systematic review of literature in MEDLINE/Pubmed, Embase and Cochrane controlled trials database and clinicaltrial.gov was performed between 1970-2022. Primary outcomes assessed were complications and stone-free rate (SFR), while eligible studies reported data on ureteroscopy and percutaneous nephrolithotripsy (PCNL). Results: 24 eligible studies (12 randomized and 12 observational) out of 834 initially screened abstracts were eligible for analysis, accounting for 4882 patients. Pooled analysis of all procedures revealed no significant differences for SFR, operative time, length of stay, minor (Clavien I-II) or major complications (Clavien III-V) between groups. Similar results were noted when subanalyses for ureteroscopy and PCNL were performed. When only randomized studies were analyzed, results were similar except that minor and major complications favored fluoroscopy-free group (RR 0.68 and 0.59 respectively). Conclusions: Pooled analysis revealed that the SFR and complication rates when fluoroscopy-free procedures are used, are similar with fluoroscopy-guided procedures. SOURCE OF Funding: None
