Laser Lithotripsy Strategies: Fragmenting, Popcorning, Dusting, and How Intrarenal Pressure Should Be Considered

Laser lithotripsy strategies include fragmenting and dusting with or without subsequent popcorning. Introduction of the thulium fiber laser has provided an efficient option particularly with a dusting strategy, though optimal settings are still being elucidated. Dusting and fragmenting with holmium yttrium aluminum garnet systems have similar clinical outcomes with shorter operative times associated with dusting. Consideration of intra-renal pressure is an important concern in ureteroscopy (URS), given risks for infectious complications associated with elevated pressures. Introduction of suction devices in URS offer improved stone clearance and better fine tuning of intra-renal pressure with improved visibility.