This meta-analysis combined data from randomized studies involving patients undergoing endourologic procedures for kidney or ureteral stones. The researchers compared fluoroless ultrasound-guided techniques against traditional fluoroscopy-guided approaches. The analysis included 1,119 patients in ureteroscopy studies and 1,370 patients in percutaneous nephrolithotomy studies.
The main finding was that fluoroless ultrasound guidance significantly reduced overall complications for percutaneous nephrolithotomy. It also led to fewer minor and major complications in that specific procedure. Stone-free rates remained equivalent between the two groups for both types of surgeries.
For ureteroscopy, overall complication rates were comparable between the two methods. However, flexible fluoroless ureteroscopy showed fewer minor complications than fluoroscopy-guided approaches. Surgical time increased slightly with the ultrasound method, but the difference was minimal.
The study supports transitioning from fluoroscopy-dependent to fluoroscopy-optional endourology. Readers should note that these results apply only to the randomized studies included in the analysis. The findings do not imply that ultrasound is better for every patient or every type of stone removal.