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Introduction: Aimed to investigate the feasibility and availability of fluoroless retrograde intrarenal surgery (fRIRS) in a large patient population., Methods: Patients who underwent fRIRS for ureteral or renal calculi in our center between June 2019 and June 2024 were reviewed. Demographic data, stone characteristics, operation time, perioperative-postoperative complications, perioperative complications, and stone-free rates of patients who underwent fRIRS for ureteral or renal calculi were evaluated. Claven-Dindo classification was used for complications. All procedures were performed under spinal or general anesthesia., Results: 1079 patients were included in the study. Of the 1079 patients, 352 (32.6%) were female and 727 (67.4%) were male. The mean age was 47.33 ± 14.31 years. The mean size of the stones was 13.1 ± 6.33 mm 3 . Of the patients, 208 (19.27%) received general anesthesia and 871 (80.73%) received spinal anesthesia. The mean operation time was 37.14 ± 17.65 min. All patients received a Double J (DJ) stent postoperatively. The rate of complications was 8% overall. The complications observed in general were minor; postoperative colic pain and hematuria were observed in 36 (3.3%) patients and 26 (2.4%) patients, respectively. Stone-free rate was 86.4%., Conclusion: The fRIRS is a safe and feasible method for the treatment of uncomplicated ureteral and renal calculi. In uncomplicated patients, it has similar complication and success rates to conventional methods and eliminates radiation exposure., Competing Interests: Declaration of competing interest The authors declares that they have no conflict of interest., (Copyright © 2025 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD., Methods: A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines., Results: Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures., Conclusion: The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)