Fluoroless versus conventional ureteroscopy for urinary stones: a systematic review and meta-analysis.

INTRODUCTION To comprehensively assess the effectiveness and safety of fluoroless ureteroscopy (URS) vs conventional URS for urinary stones. EVIDENCE ACQUISITION An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were performed to find eligible researches before May 2020. Result parameters including stone-free rate (SFR), operation time, repeat procedure rate and complication rate were assessed using RevMan 5.3. EVIDENCE SYNTHESIS 7 studies (5 retrospective studies and 2 prospective randomized controlled trials) involving 1404 individuals were included. Pooled results demonstrated that the operation time in fluoroless URS group was slightly longer than conventional URS group (weighted mean difference [MD]=2.79, p=0.0001), but no statistically significant differences regarding SFR (odds ratio [OR]=1.18, p=0.57), repeat procedure rate (OR=1.32, p=0.52), and total complication rate (OR=0.75, p=0.16) were observed between two techniques. CONCLUSIONS Fluoroless URS is equally safe and effective to conventional URS procedure with zero radiation exposure. However, it needs to be cautiously conducted in selected patients and fluoroscopy equipment should always be available intraoperatively.