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Radiation exposure of patients during endourological procedures

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Abstract

Purpose

Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS).

Methods

Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards.

Results

RD was generally highest for PCNL, reaching levels up to 33 mSv, 28,700 mGycm2, and 430.8 mGy. This was followed by SWL, with RD reaching up to 7.32 mSv, 13,082 mGycm2, and 142 mGy. URS demonstrated lower RD, reaching up to 6.07 mSv, 8920 mGycm2, and 46.99 mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD.

Conclusions

This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.

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Data availability

The data that support the findings of this study are available from the authors upon reasonable request.

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Author notes

  1. Vincent De Coninck and Xavier Mortiers have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium

    Vincent De Coninck

  2. Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands

    Vincent De Coninck & Etienne X. Keller

  3. Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Xavier Mortiers, Laura Hendrickx & Stefan De Wachter

  4. GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France

    Olivier Traxer

  5. Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France

    Olivier Traxer

  6. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Etienne X. Keller

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  4. Stefan De Wachter
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  5. Olivier Traxer
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  6. Etienne X. Keller
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Contributions

Vincent De Coninck: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. Xavier Mortiers: Data collection or management, Data analysis, Manuscript writing/editing. Laura Hendrickx: Data collection or management, Data analysis. Stefan De Wachter: Manuscript writing/editing. Olivier Traxer: Manuscript writing/editing. Etienne Xavier Keller: Data analysis, Manuscript writing/editing.

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Correspondence to Vincent De Coninck.

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Conflict of interest

Vincent De Coninck is a speaker and/or consultant for BD, Coloplast, and Karl Storz, and has no specific conflicts relevant to this study. Olivier Traxer is a consultant for Coloplast, Karl Storz, Rocamed, Quanta Systems, Ambu, Boston Scientific, and IPG Medical, and has no specific conflicts relevant to this study. Etienne Xavier Keller is a speaker and/or consultant for Coloplast, Olympus, Boston Scientific, Recordati, Debiopharm and Alnylam, and has no specific conflicts of interest relevant to this work. All other authors have no conflicts of interest.

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De Coninck, V., Mortiers, X., Hendrickx, L. et al. Radiation exposure of patients during endourological procedures. World J Urol 42, 266 (2024). https://doi.org/10.1007/s00345-024-04953-y

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