Dusting versus fragmentation for large proximal ureteral stones during flexible ureteroscopy: A prospective...

Recent advances in endoscopic technology have empowered urologists to treat most types of stones within the urinary tract effectively. Available treatments for ureteral stones using a laser lithotripter include fragmentation, the active removal of fragments with a basket, and dusting. To date, only a few prospective randomized studies have endorsed the use of stone dusting, fragmentation, and active removal for ureteric stones.

This randomized, prospective, comparative study was conducted in the Urology Department. Sixty patients with proximal ureteral stones from July 2019 to July 2020 were included and randomly divided into 2 groups using a random number generator program (version 2, 2015). In Group 1, the stones were fragmented into dust (n = 30), and in Group 2, lithotripsy produced extractable fragments (n = 30).

In this study, the Ho:YAG laser was used to dust stones at low energy and high frequency (0.4-0.6 J and 20-30 Hz). Using the Ho:YAG laser set to high energy and low frequency (1.5-2 J and 8-10 Hz), stone fragmentation was achieved. The mean stone size was 1.63 cm in Group 1 and 1.69 cm in Group 2. The stone-free rates for the dusting and fragmentation groups were 96.6% and 86.6%, respectively. Meanwhile, the mean operative time was 87.6 ± 33.6 minutes in the dusting group and 80.4 ± 28.8 minutes in the fragmentation group. There were no postoperative complications with the dusting technique, compared with a 13.3% complication rate with the fragmentation technique.

For proximal ureteral stones, the stone-free rates between the dusting and fragmentation procedures were comparable. Both techniques proved to be effective.