Pulsed Fluoroscopy in Ureteroscopy and Percutaneous Nephrolithotomy

OBJECTIVE To assess the impact of pulsed fluoroscopy (PF) at a rate of 4 frames per seconds (fps) on the total fluoroscopy time during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). METHODS A retrospective review of prospectively collected data was performed for consecutive patients undergoing URS and PCNL by a single surgeon between July 2009 and July 2011. PF was routinely used in all URS procedures since January 2011 and in all PCNL procedures since November 2010. Before these dates, standard fluoroscopy (SF) at a rate of 30 fps was used. Patient and stone characteristics together with operative data were compared using univariate and multivariate analyses. RESULTS There were a total of 163 URS (117 SF and 46 PF) and 100 PCNL (50 SF and 50 PF). In the URS cohort, there were no significant differences between both SF and PF groups in terms of age, gender, body mass index, stone location, and multiplicity (P >=.20). For both URS and PCNL cohorts, the duration of surgery and stone-free rates were comparable in both SF and PF groups (P >=.06). Compared with SF groups, patients in the PF groups were exposed to significantly less fluoroscopy during URS (109.1 vs. 44.1 sec, P <0.001) and PCNL (341.1 vs. 121.5 sec, P <0.001). These differences in mean fluoroscopy times retained their significance in multivariate analyses (P <.001). CONCLUSION The use of PF during URS and PCNL was associated with significantly lower fluoroscopy time, thus reducing radiation exposure to both patients and personnel. UROLOGY 79: 1230-1235, 2012. (c) 2012 Elsevier Inc.