Fluoro-less Ureteral Stent Placement Following Uncomplicated Ureteroscopic Stone Removal: A Feasibility Study


      To test the feasibility of ureteral stent placement without image guidance after uncomplicated ureteral stone removal and to compare the outcomes of fluoro-less and conventional ureteral stent placement.


      A technique was devised to allow placement of a ureteral stent without image guidance by substituting fluoroscopy with visual and tactile cues. A retrospective review of 25 patients using fluoro-less stent placement was compared with 25 consecutive patients who underwent conventional stent placement with fluoroscopy. Stent placement was graded on a 6-point scale to assess coil symmetry and location. Comparisons between the fluoro-less stent placements and controls were performed with the Mann-Whitney U test. All hypotheses were 2-sided and conducted at an alpha level of 0.05.


      All 25 ureteral stent placements were performed successfully without the use of fluoroscopy for image guidance. There was no significant difference in age, gender, body mass index, stone size, or complication rates when fluoro-less and conventional stent placements were compared. In addition, grade 1 placement was achieved in 76% of the fluoro-less group and in 64% of the conventional group. Although placement accuracy was higher in the fluoro-less group this was not statistically significant (P = .13).


      Ureteral stent placement without fluoroscopic guidance is feasible. It maintains comparable efficacy and complication rates with conventional ureteral stent placement. This technique allows reduced radiation exposure in patients requiring ureteral stent placement.
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        • Zimskind P.D.
        • Fetter T.R.
        • Wilkerson J.L.
        Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically.
        J Urol. 1967; 97: 840-844
        • Preminger G.M.
        • Tiselius H.G.
        • Assimos D.G.
        • et al.
        Guideline for the management of ureteral calculi.
        J Urol. 2007; 2007: 2418-2434
        • Mardis H.K.
        • Hepperlen T.W.
        • Kammandel H.
        Double pigtail ureteral stent.
        Urology. 1979; 14: 23-26
        • Jarrard D.J.
        • Gerber G.S.
        • Lyon E.S.
        Management of acute ureteral obstruction in pregnancy utilizing ultrasound-guided placement of ureteral stents.
        Urology. 1993; 42: 263-267
        • Elgamasy A.
        • Elsherif A.
        Use of Doppler ultrasonography and rigid ureteroscopy for managing symptomatic ureteric stones during pregnancy.
        BJU Int. 2010; 106: 262-266
        • Berrington de González A.
        • Darby S.
        Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.
        Lancet. 2004; 363: 345-351
        • US Food and Drug Administration
        Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging.
        • Mandan R.C.
        • Eliseo V.C.
        • Brian F.M.
        • et al.
        Radiological protection in fluoroscopically guided procedures performed outside the Imaging Department; 2011.
        (Accessed November 1, 2011)
        • Finney R.P.
        Experience with new double J ureteral catheter stent.
        J Urol. 1978; 120: 678-681
        • Wilson C.H.
        • Bhatti A.A.
        • Rix D.A.
        • et al.
        Routine intraoperative ureteric stenting for kidney transplant recipients.
        Cochrane Database Syst Rev. 2005; (CD004925)
        • Chen G.L.
        • Bagley D.H.
        Fluoroscopic placement of double-pigtail ureteral stents.
        Endoscopy. 2001; 7: 175-180
        • Wu N.Z.
        • Auge B.K.
        • Preminger G.M.
        Simplified ureteral stent placement with the assistance of a ureteral access sheath.
        J Urol. 2001; 166: 206-208
        • Fabrizio M.D.
        • Gray D.S.
        • Feld R.I.
        • et al.
        Placement of ureteral stents in pregnancy using ultrasound guidance.
        Tech Urol. 1996; 2: 121-125
        • National Research Council
        Health Risk from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2.
        in: National Academies Press, Washington DC2006: 7-8
        • Krupp N.
        • Bowman R.
        • Tenggardjaja C.
        • et al.
        Fluoroscopic organ and tissue-specific radiation exposure by sex and body mass index during ureteroscopy.
        J Endourol. 2010; 24: 1067-1072
        • Ngo T.C.
        • Macleod L.C.
        • Rosenstein D.I.
        • et al.
        Tracking intraoperative fluoroscopy utilization reduces radiation exposure during ureteroscopy.
        J Endourol. 2011; 25: 763-767
        • Proschek D.
        • Kafchitsas K.
        • Rauschmann M.A.
        • et al.
        Reduction of radiation dose during facet joint injection using the new image guidance system SabreSource: a prospective study in 60 patients.
        Eur Spine J. 2009; 18: 546-553
        • Uradomo L.T.
        • Goldberg E.M.
        • Darwin P.E.
        Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial.
        Gastrointest Endosc. 2007; 66: 84-89
        • Greene D.J.
        • Tenggadjaja C.F.
        • Bowman R.J.
        • et al.
        Comparison of a reduced radiation fluoroscopy protocol to conventional fluoroscopy during uncomplicated ureteroscopy.
        Urology. 2011; 78: 286-290
        • Ewert P.
        • Berger F.
        • Daehnert I.
        • et al.
        Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method.
        Circulation. 2000; 101: 847-849
        • Faletra F.F.
        • Regoli F.
        • Nucifora G.
        • et al.
        Real-time, fluoroless, anatomic-guided catheter navigation by 3D TEE during ablation procedures.
        JACC Cardiovasc Imaging. 2011; 4: 203-206
        • Puri R.
        • Eloubeidi M.A.
        • Sud R.
        • et al.
        Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance.
        J Gastroenterol Hepatol. 2010; 25: 1416-1419
        • Stavropoulos S.
        • Larghi A.
        • Verna E.
        • et al.
        Therapeutic endoscopic retrograde cholangiopancreatography without fluoroscopy in four critically ill patients using wire-guided intraductal ultrasound.
        Endoscopy. 2005; 37: 389-392
        • Kotil K.
        • Bilge T.
        Accuracy of pedicle and mass screw placement in the spine without using fluoroscopy: a prospective clinical study.
        Spine J. 2008; 8: 591-596
        • McGee S.M.
        • Routh J.C.
        • Granberg C.F.
        • et al.
        Sacral neuromodulation in children with dysfunctional elimination syndrome: description of incisionless first stage and second stage without fluoroscopy.
        Urology. 2009; 73: 641-644
        • Mandhani A.
        • Chaudhury H.
        • Gupta N.
        • et al.
        Is fluoroscopy essential for retrieval of lower ureteric stones?.
        Urol Int. 2007; 78: 70-72

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