Dusting versus fragmentation for renal stones during flexible ureteroscopy
Affiliations
Affiliations
- Urology Unit, Surgery Department, Al-Amiri Hospital, Kuwait City, Kuwait.
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Abstract
Objectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi. Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3-0.5 J and 15-20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1-1.2 J and 6-10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared. Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients' demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244). Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures. Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath.
Keywords: Dusting; Flexible ureteroscopy; laser; renal calculi; stones.
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KMEL References
References
-
- Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69:475–482. - PubMed
-
- Giusti G, Proietti S, Villa L, et al. Current standard technique for modern flexible ureteroscopy: tips and tricks. Eur Urol. 2016;70:188–194. - PubMed
-
- El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int. 2012;110:898–902. - PubMed
-
- Mi Y, Ren K, Pan H, et al. Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis. Urolithiasis. 2016;44:353–365. - PubMed
-
- Sea J, Jonat LM, Chew BH, et al. Optimal power settings for holmium: yAGlithotripsy. J Urol. 2012;187:914–919. - PubMed
-
- Miernik A, Wilhelm K, Ardelt PU, et al. Standardized flexible ureteroscopic technique to improve stone-free rates. Urology. 2012;80:1198–1202. - PubMed
-
- Wiener SV, Deters LA, Pais VM. Effect of stone composition on operative time during ureteroscopic holmium: yttrium-aluminum-garnet laser lithotripsy with active fragment retrieval. Urology. 2012;80:790–794. - PubMed
-
- Hecht SL, Wolf JS. Techniques for holmium laser lithotripsy of intrarenal calculi. Urology. 2013;81:442–445. - PubMed
-
- Patel AP, Knudsen BE. Optimizing use of the holmium: yAGlaser for surgical management of urinary lithiasis. Curr Urol Rep. 2014;15:397. - PubMed
-
- Humphreys MR, Shah OD, Monga M, et al. Dusting versus basketing during ureteroscopy – which technique is more efficacious? A prospective multicenter trial from the EDGE research consortium. J Urol. 2018;199:1272–1276. - PubMed
-
- Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189:580–584. - PubMed
-
- Tefekli A, Ali Karadag M, Tepeler K, et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol. 2008;53:184–190. - PubMed
-
- Matlaga BR, Chew B, Eisner B, et al. Ureteroscopic laser lithotripsy: a review of dusting vs fragmentation with extraction. J Endourol. 2018;32:1–6. - PubMed
-
- Chew BH, Brotherhood HL, Sur RL, et al. Natural history, complications and re-intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE research consortium. J Urol. 2016;195:982–986. - PubMed
-
- Tracey J, Gagin G, Morhardt D, et al. Ureteroscopic high-frequency dusting utilizing a 120-W holmium laser. J Endourol. 2018;32:290–295. - PubMed
-
- Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22:233–236. - PubMed
-
- Desai MR, Ganpule A. Flexible ureterorenoscopy. BJU Int. 2011;108:462–474. - PubMed