Clinical Research Directory

Comparison of Limited Fluoroscopy and Conventional URSL

Background: Ureteroscopic lithotripsy (URSL) is the standard treatment for ureteric stones. Conventional URSL employs routine fluoroscopy for guidewire positioning, scope advancement, stent placement, and complication detection. While facilitating the procedure, this approach exposes patients and operating theatre staff to ionizing radiation, with attendant long-term health risks and occupational hazards from lead apron use. Retrospective and prospective case series have suggested that URSL can be performed safely with limited or no fluoroscopy using direct endoscopic visualization and tactile feedback. However, no randomized controlled trial has directly compared the stone clearance rates and radiation exposure between these two approaches. Purpose: This two-center prospective randomized controlled trial aims to evaluate the feasibility and radiation exposure of limited-fluoroscopy URSL and to compare its complication profile, operative outcomes, and stone-free rates against conventional fluoroscopy-guided URSL. Study question: Does a limited-fluoroscopy protocol significantly reduce intraoperative radiation dose without compromising the success rate, safety, or operative efficiency of ureteroscopic lithotripsy? Methods: A total of 60 adult patients (≥18 years) with ureteric stones scheduled for URSL will be randomized in a 1:1 ratio to either the limited-fluoroscopy arm (fluoroscopy used only at surgeon's discretion for safety, with primary reliance on endoscopic landmarks) or the conventional arm (routine fluoroscopy throughout the procedure). The primary endpoint is radiation exposure (mGy). Secondary endpoints include stone-free rate at follow-up, operative time, intraoperative and postoperative complications, and need for auxiliary procedures.

Flexible vs Semi-rigid URS

To compare the efficacy, safety, success rate, operative time, and cost-effectiveness of flexible ureteroscopy versus semirigid ureteroscopy in the management of upper ureteric stones smaller than 2 cm. The investigators' main concern in this study is Upper third ureteric stones to determine which cases can be treated with Semi-Rigid Ureteroscopy, and which one needs flexible ureteroscopy. This depends on several factors: 1. Division of the upper third of the ureter 2. Stone size 3. Stone impaction 4. Surgeon experience 5. Anesthesia 6. Ureteric dilatation above the stone 7. Mini endoscopy

Efficacy of Intra-Ureteric Aminophylline Installation After Failed Stone Accessibility by Semi-rigid Ureteroscopy. Prospective Trial

In this study we will test the effect of local intraureteric aminophylline instillation through Ureteric stent and Reaching stone without the need of ballon dilataion