Extractable fragment versus dusting during ureteroscopic laser lithotripsy in children: Prospective randomized study

Area of Science:

• Pediatric Urology
• Endourology
• Laser Surgery

Background:

• Complete stone fragment eradication is crucial in pediatric stone management.
• Ureteroscopic laser lithotripsy techniques raise concerns regarding operative time, morbidity, costs, and endoscope damage.

Purpose of the Study:

• To compare outcomes of fragmentation into extractable pieces versus stone dusting during ureteroscopic laser lithotripsy in children.

Main Methods:

• 100 children with ureteral stones were randomized into two groups: stone dusting (n=50) or extractable fragments (n=50).
• Different holmium laser settings were used: low power/high frequency for dusting, high power/reduced frequency for extractable fragments.
• Fragmentation time, operative time, stone-free rate, and complications were compared.

Main Results:

• Mean fragmentation and operative times were significantly lower in the extractable fragments group (p=0.008 and 0.0069, respectively).
• Minor complications (hematuria, UTI) occurred in 8 cases (5 in dusting group, 3 in extractable group).
• No major complications were observed in either group.

Conclusions:

• Fragmenting stones into extractable pieces significantly reduces fragmentation and operative times compared to stone dusting.
• This approach demonstrates similar stone-free and complication rates.
• Ureteroscopic laser lithotripsy yielding extractable fragments is an effective and time-saving pediatric procedure.