Stone dust in endourology: a systematic review of its definition, management, and clinical impact

To evaluate and synthesise the existing literature on stone dust (DUST) in endourology, focusing on its definition, creation methods, and removal techniques.

A comprehensive electronic literature search was conducted using the PubMed/Medline, Web Of Science, and Embase databases to identify reports published until October 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes assessed included the definition of DUST, the method by which DUST was created, and how it was removed, evaluating both in vitro and in vivo studies. The review also assessed the efficacy of different laser technologies, including holmium-yttrium-aluminium-garnet (Ho:YAG) laser, thulium fibre laser (TFL), and pulsed thulium-YAG laser (p-Tm:YAG) laser, in generating DUST and their clinical relevance in stone management.

The systematic review identified 43 eligible studies, revealing significant variability in the definition and evaluation of DUST. Criteria for DUST ranged from sub-millimetre particle sizes to functional properties like floatability and aspiration capability. While Ho:YAG lasers remain widely used for stone dusting, emerging technologies such as TFL and p-Tm:YAG lasers have shown superior efficiency in producing finer particles and reducing retropulsion. No consensus emerged regarding the settings used by surgeons and the pre-settings provided by laser manufacturers.

Despite the widespread use of dusting techniques in endourology, a standardised definition of DUST remains lacking, with significant variability in laser settings, particle sizes, and evacuation methods. It must be clarified whether DUST should be defined as a noun-representing a distinct entity with a precise definition-or as the result of the dusting process, in which case clear criteria are needed to characterise it accurately. Establishing standardised definitions and protocols through international consensus is crucial to optimising clinical outcomes and ensuring consistency in future research.