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• W2000763938 abstract "No AccessJournal of UrologyAdult Urology1 Dec 2014Ultrasound Guided Ureteroscopy for the Definitive Management of Ureteral Stones: A Randomized, Controlled Trial Levi A. Deters, Lawrence M. Dagrosa, Benjamin W. Herrick, Anne Silas, and Vernon M. Pais Levi A. DetersLevi A. Deters More articles by this author , Lawrence M. DagrosaLawrence M. Dagrosa More articles by this author , Benjamin W. HerrickBenjamin W. Herrick More articles by this author , Anne SilasAnne Silas More articles by this author , and Vernon M. PaisVernon M. Pais Financial interest and/or other relationship with Clinical Nephrology. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.06.073AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ureteroscopy is central to the surgical management of ureteral stones. Fluoroscopy is conventionally used for intraoperative guidance, although there is growing effort to decrease the exposure of patients and staff to ionizing radiation. We developed a radiation-free approach to ureteroscopy using ultrasound guidance to manage ureteral stones. To our knowledge we present the first randomized trial to study its safety and efficacy. Materials and Methods: This single center, randomized clinical trial from 2011 to 2013 enlisted patients who presented with symptomatic ureteral stones 8 mm or less without a significant ipsilateral stone burden. Patients were randomly assigned to 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 flank to visualize the collecting system of the ipsilateral kidney. We compared operative time, stone size, stone-free status and complication rates between the 2 groups. Results: A total of 50 patients were enrolled in study with 25 per arm. There was no difference in stone size (5.9 vs 5.7 mm), patient age (56 vs 52 years) or body mass index (31 vs 30 kg/m2) in the test group compared to controls. The ultrasound guidance cohort showed no significant difference in the stone-free rate (86% vs 86%) or the complication rate (8% vs 16%) compared to controls. Operative time was no longer in the ultrasound guidance cohort. Conclusions: In this feasibility study we found that ureteral stones may be definitively managed in a timely, effective and safe fashion without ionizing radiation in the general population using this novel technique of ultrasound guided ureteroscopy. References 1 : Prevalence of kidney stones in the United States. Eur Urol2012; 62: 160. Google Scholar 2 : Economics and cost of care with stone disease. Adv Chronic Kidney Dis2009; 16: 5. Google Scholar 3 : Guideline for the management of ureteral calculi. J Urol2007; 178: 2418. Link, Google Scholar 4 : Current and future imaging for urologic interventions. Curr Opin Urol2008; 18: 116. Google Scholar 5 : Ultrasound guided ureteroscopy in pregnancy. Clin Nephrol2013; 79: 118. Google Scholar 6 : The resource-based relative value scale: methods, results and impacts on urology. J Urol1993; 150: 981. Link, Google Scholar 7 : Sources and Effects of Ionizing Radiation. New York: United Nations2000. Google Scholar 8 : National Council on Radiation Protection Report 160. Bethesda: National Council on Radiation Protection and Measurements2009. Google Scholar 9 : Radiation Cataract. New Insights on Risk and Basic Safety Standards. Brussels: European Commission2007: 81. Google Scholar 10 : Increased brain cancer risk in physicians with high radiation exposure. Radiology2005; 235: 709. Google Scholar 11 : Occupational health hazards in the interventional laboratory: time for a safer environment. J Vasc Interv Radiol2009; 20: 147. Google Scholar 12 : Fluoroless ureteroscopy: zero-dose fluoroscopy during ureteroscopic treatment of urinary-tract calculi. J Endourol2013; 27: 432. Google Scholar 13 : Totally ultrasonography-guided percutaneous nephrolithotomy in the flank position. J Endourol2009; 22: 1453. Google Scholar 14 : Management of acute ureteral obstruction in pregnancy utilizing ultrasound-guided placement of ureteral stents. Urology1993; 42: 263. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCanales B, Sinclair L, Kang D, Mench A, Arreola M and Bird V (2015) Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in PatientsJournal of Urology, VOL. 195, NO. 4 Part 1, (992-997), Online publication date: 1-Apr-2016.Assimos D (2018) Re: Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time during Unilateral UreteroscopyJournal of Urology, VOL. 193, NO. 1, (171-171), Online publication date: 1-Jan-2015. Volume 192Issue 6December 2014Page: 1710-1713 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.KeywordsultrasonographyureterionizingradiationureteroscopyurolithiasisMetricsAuthor Information Levi A. Deters More articles by this author Lawrence M. Dagrosa More articles by this author Benjamin W. Herrick More articles by this author Anne Silas More articles by this author Vernon M. Pais Financial interest and/or other relationship with Clinical Nephrology. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2000763938 title "Ultrasound Guided Ureteroscopy for the Definitive Management of Ureteral Stones: A Randomized, Controlled Trial" @default.
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