Comparison of efficacy and safety of fluoroscopy-free and conventional retrograde ureteroscopy for urolithiasis: a systematic review and metanalysis of randomized controlled trials.

Introduction: Urolithiasis is a highly prevalent condition and its definitive treatment with endourological procedures exposes patients and medical staff to ionizing radiation. The efficacy and safety of fluoroscopy-free ureteroscopy (FF-URS) over conventional ureteroscopy (CV-URS) are controversial.

Evidence acquisition: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) data comparing FF-URS to CV-URS in patients undergoing treatment for ureteral or kidney stones.

Evidence synthesis: Eight randomized controlled trials (RCTs) were included in the meta-analysis, comprising 873 patients. Of these, 440 (50.4%) patients underwent FF-URS. The meta-analysis revealed no statistically significant difference in stone-free rate (SFR) between the two groups (RR=0.99; 95% CI 0.94-1.04; P=0.65; I²=0%). Similarly, there was no difference in the overall complication rates (8.4% vs. 9.7%; RR 0.87; 95% CI 0.57-1.31; P=0.50; I²=0%), Clavien-Dindo I/II (RR=0.68; 95% CI 0.42, 1.10; P=0.12; I²=0%) and operative time (MD 1.58 min; 95% CI -0.02-3.18; P=0.05; I²=16%). Clavien-Dindo III occurred only in one patient (0.2%) in the FF-URS group.

Conclusions: FF-URS is effective and safe compared to CV-URS and can reduce radiation exposure for both patients and medical staff without compromising treatment outcomes.