Ureteroscopic High-Frequency Dusting Utilizing a 120-W Holmium Laser.

Area of Science:

• Urology
• Endourology
• Laser Lithotripsy

Background:

• Advancements in laser technology enable new approaches for urinary stone ablation.
• The dusting technique, using high-frequency and low-pulse energy (HiFr-LoPE), is gaining interest for ureteroscopy (URS).

Purpose of the Study:

• To assess the efficacy and safety of a 120-W holmium laser utilizing HiFr-LoPE settings for stone dusting during URS.
• To evaluate residual fragment (RF) rates and complication profiles associated with this lithotripsy method.

Main Methods:

• A retrospective review of consecutive URS cases performed by a single surgeon using a 120-W holmium laser (P120H).
• Lithotripsy was conducted using HiFr-LoPE settings (50-80 Hz/0.2-0.5 J).
• Residual fragments were assessed postoperatively via imaging, and complications were graded using the Clavien-Dindo system.

Main Results:

• URS was performed on 82 renal units; 84% of cases exclusively used the dusting technique.
• Zero-fragment and ≤2 mm RF rates were 62.1% and 74.2%, respectively.
• 13% of patients experienced complications (Clavien-Dindo grade 1 or 2), with no hospitalizations or reinterventions.

Conclusions:

• The HiFr-LoPE dusting technique with a 120-W holmium laser demonstrates acceptable residual fragment and complication rates in URS.
• While effective for many stones, the optimal role of dusting requires further investigation as not all stones are amenable to this method.