Can We Avoid Radiation Exposure in Retrograde Intrarenal Surgery?

<i>Background and Objectives:</i> The use of fluoroscopy during retrograde intrarenal surgery (RIRS) results in cumulative ionizing radiation exposure to both the patient and the surgical team. We aimed to evaluate the efficacy and safety of fluoroscopy-free (FF) RIRS performed by experienced surgeons in the management of renal stones < 2 cm. <i>Materials and Methods:</i> A total of 255 patients who underwent RIRS for renal stones < 2 cm between 2023 and 2025 were retrospectively analyzed. Patients were randomly assigned to the groups. Fluoroscopy was used (FU) during RIRS in 123 patients, whereas fluoroscopy was not used during RIRS in 132 patients. All procedures were performed by a single experienced surgeon. For patients in both groups, the following variables were retrospectively reviewed: demographic characteristics, stone characteristics, localization, and diameter, operative time, fluoroscopy time and dose, postoperative complications, length of hospital stay, and stone-free rates (SFR). <i>Results:</i> The operative time was 34.7 ± 8.7 min in the FF group and 42.0 ± 12.9 min in the FU group, being significantly shorter in the FF group (<i>p</i> < 0.001). No fluoroscopy was used in the FF group, whereas in the FU group the fluoroscopy time and dose were recorded as 7.75 ± 3.6 s and 1.31 ± 0.61 mGy, respectively. There were no significant differences between the groups in terms of length of hospital stay or SFR. No intraoperative complications were observed in either group. Postoperative complications occurred in 29 (21.9%) patients in the FF group and 42 (34.1%) patients in the FU group; the difference between groups was statistically significant (<i>p</i> = 0.030). <i>Conclusions:</i> In appropriately selected patients with renal stones < 2 cm, fluoroscopy-free RIRS performed by experienced surgeons can be applied effectively and safely, with shorter operative times and lower complication rates.