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INTRODUCTION: The goal of this study was to assess the results of 248 patients who underwent fluoroscopy-free retrograde intrarenal surgery METHODS: Between January 2017 and March 2020, 248 cases of retrograde intrarenal surgery (RIRS) were conducted using an access sheath and guidewire. Using ureteroscopy, two hydrophilic guide wires were inserted into the renal pelvis under direct eyesight (URS). When the ureter could not be entered with the 9.5 Fr URS, the ureter was first entered using the 7.5 Fr URS. Then, without flouroscopy, an access sheath was pushed up to the proximal ureter while examining the opening with URS. When an access sheath could not be placed, a double J stent was implanted.. The operation was repeated after 3 weeks. The procedure's success rate was determined by the absence of stones or the presence of leftover fragments smaller than 3 mm RESULTS: The study included 161 (64.9%) male and 87 (35.1%) female patients with a mean age of 44.03 (± 16.04), (range 18-81) years. Mean stone size was 14.7 (± 3.7)mm. The mean operation time was 62.34 (± 8.2)minutes. Stone-free rate was 88.7% (n: 220). 28 of the patients had residual stone. Twenty patients (8%) had minor complications, including hematuria and fever and in 2 patients (0.8%) subcapsular hematoma was developed. DISCUSSION AND CONCLUSION: Kidney stones can be treated successfully with minimal morbidity and mortality. The insertion of an access sheath under urs guidance is possible without the need of fluoroscopy. Patients and surgeons are exposed to less radiation as a result of this procedure

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