Patients with urolithiasis are exposed to significant amounts of radiation during their initial work-up, surgical treatment, and follow-up. The purpose of this study was to determine the feasibility of performing ureteroscopy without fluoroscopy. In addition, we compared patients treated using a completely fluoroless ureteroscopic technique with a cohort of conventional ureteroscopies performed using fluoroscopy.A retrospective review of 50 consecutive patients undergoing fluoroless ureteroscopy was performed. These procedures were performed by inserting guidewires and instruments using tactile feedback, direct visualization, and external visual cues to substitute for fluoroscopy. In addition, this cohort was compared with 50 conventional, fluoroscopy-guided ureteroscopies performed in the same time period.Fifty ureteroscopies were performed without image guidance. For this cohort, the mean operative time was 59.2 minutes, overall stone burden was 91.53 mm(2), complication rate was 4%, and repeat procedure rate was 8%. Compared with conventional ureteroscopy the fluoroless ureteroscopy patients had a larger stone burden (p=0.042; 91.53 vs 56.58 mm(2)), but similar age, gender, American Society of Anesthesiologists (ASA) score, body-mass index, operative time, complication rate, and repeat procedure rate.This study demonstrates the feasibility and efficacy of the completely fluoroless ureteroscopic treatment of calculi throughout the entire upper urinary tract while completely removing radiation exposure to the patients and staff. Although this fluoroless technique may be most applicable in patients at highest risk for radiation exposure, such as pregnant women, children, and recurrent stone formers, it offers an alternative for reduction of radiation in all patients.