Mp28-04 Flexible Urs Holmium Laser Stone Dusting vs Fragmentaion for 2 Cm Single Renal Stone

Gamal, Wael; Mamdouh, Ahmed

doi:10.1016/j.juro.2015.02.1227

Cited by 4 publications

(6 citation statements)

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“…The stone size in our series w as larger but similar to their study, no hospital readmissions were necessary. Clear advantages of dusting include a shorter procedure time and reduced risk of ureteral trauma [10]. However, this will need to be balanced with the SFR of fragmentation and retrieval technique which seems to be superior [5, 11].…”

Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to 'dust' and 'pop-dust' the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017-April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3-0.6 J and a frequency of 20-50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2-88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3-23 mm) and 21 mm (range 15-52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

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Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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“…Two recent studies have demonstrated 40% and 20% reductions in operative times associated with the dusting technique. 9,13 Another potential advantage for dusting is decrease in use of ureteral access sheaths, which may lead to decreases in ureteral trauma. The initial cohort for the Post-Ureteroscopic Lesion Scale study reported that ureteral access sheath was associated with some ureteral trauma in 57% of patients (superficial or submucosal lesion).…”

Section: Rationale For Dustingmentioning

confidence: 99%

“…It has also been reported that basket-associated complications are reduced with dusting. 13 In addition, as there is less of a need for multiple implements to be passed through the ureteroscope's working channel, there may be greater scope longevity with this approach.…”

Section: Rationale For Dustingmentioning

confidence: 99%

Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction

Matlaga

Chew

Eisner

et al. 2018

Journal of Endourology

110

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Both dusting and fragmentation with extraction approaches to ureteroscopic stone treatment are effective. In fact, there is little evidence that one approach is better than the other. However, each does have relative advantages and disadvantages, which should be considered. Although dusting tends to be associated with shorter procedure times and a lower risk of ureteral damage, this approach may place the patient at increased risk for future stone events should all of the resultant debris not be expelled from the collecting system. The active removal associated with fragmentation with extraction, in contrast, may provide for a more complete initial stone clearance.

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“…This is the reason why many urologists prefer to use a “dusting” technique [ 72 – 74 ]. Although dusting settings with low pulse energies (0.2–0.5 J), higher frequencies, and preferably longer pulse lengths ablate less stone material per unit time, it has several advantages: it decreases the use of ureteral access sheaths and therefore reduces potential ureteral trauma [ 75 ••, 76 ]; basket-associated complications are reduced because dust is naturally eliminated [ 73 ]; in the long run, it even reduces operative time by 20–40% by avoiding lengthy extraction procedures [ 73 , 75 ••, 76 ]. Besides using low pulse energies for dusting, some authors also recommend keeping the laser fiber slightly away from the stone to “defocus” it and produce smaller fragments [ 75 ••].…”

Section: Bibliographic Search Resultsmentioning

confidence: 99%

“…In summary, considering the aforementioned issues, and with very few exceptions, patient-related safety and complications are probably less dependent on the laser technology itself, but dependent on multiple other factors relating to the procedure, e.g., the surgeon’s skill, the use of ureteral access sheaths, basketing instead of dusting, good intraoperative visibility, and operative time [ 63 ••, 73 , 75 ••, 110 ].…”

Section: Bibliographic Search Resultsmentioning

confidence: 99%

Advances in Lasers for the Treatment of Stones—a Systematic Review

2018

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Purpose of ReviewLaser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year.Recent FindingsVariable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and “cleaving only” fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology.SummaryLaser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.

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Mp28-04 Flexible Urs Holmium Laser Stone Dusting vs Fragmentaion for 2 Cm Single Renal Stone

Cited by 4 publications

References 0 publications

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction

Advances in Lasers for the Treatment of Stones—a Systematic Review

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