Comparison and outcomes of dusting versus stone fragmentation and extraction in retrograde intrarenal surgery: results of a systematic review and meta-analysis

Gauhar, Vineet; Teoh, Jeremy Yuen‐Chun; Mulawkar, Prashant Motiram; Tak, Gopal; Wroclawski, Marcelo Langer; Robles-Torres, José Iván; Chan, Vinson Wai-Shun; Rojo, Esther García; Silva, Rodrigo Donalisio da; Tanıdır, Yılören; Tiong, Ho Yee; Şener, Tarık Emre; Heldwein, Flávio Lobo; Somani, Bhaskar; Castellani, Daniele

doi:10.5173/ceju.2022.0148

Cited by 17 publications

(5 citation statements)

References 30 publications

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“…Variables which have been suggested in previous literature to impact SFR (ie, age, gender, total operation time, lasing time, multiple stones, stone diameter, stone location, presence of normal/abnormal kidney anatomy, pre-stenting, disposable or reusable scope, stone clearance modality) were entered into a multivariable model to assess their significance as independent predictors. [19][20][21][22] These predictors were described using OR, 95% CI, and P values.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

et al. 2023

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Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

et al. 2023

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“…Although no difference between the two strategies was found in the EDGE study from North America, it is important to point out, though, that almost none of the patients had a CT scan for follow-up ( 27 ). A recent meta-analysis of 10 studies found no significant difference for SFR, re-treatment rate or complications ( 28 ). In that study, the most popular dusting settings were 0.2–0.5 J and 15–20 Hz (3–10 Watts).…”

Section: Methodsmentioning

confidence: 99%

“…In addition to the predominant use of plain XR to assess SFR, none of the studies to date have employed TFL, which lends itself to dusting. Consensus is still lacking regarding what constitutes dust and definitions currently range between 200 and 400 μm sized particles ( 28 , 29 ). In practical terms, it could be considered the particles of such size that can be aspirated through the working channel of the ureteroscope.…”

Section: Methodsmentioning

confidence: 99%

Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond

Juliebø-Jones,

Keller,

De Coninck

et al. 2023

Front. Surg.

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Ureteroscopy has become an increasingly popular surgical intervention for conditions such as urinary stone disease. As new technologies and techniques become available, debate regarding their proper use has risen. This includes the role of single use ureteroscopes, optimal laser for stone lithotripsy, basketing versus dusting, the impact of ureteral access sheath, the need for safety guidewire, fluoroscopy free URS, imaging and follow up practices are all areas which have generated a lot of debate. This review serves to evaluate each of these issues and provide a balanced conclusion to guide the clinician in their practice.

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“…The frequency of UAS use in the basket group was higher than that in the dust removal group to facilitate better use of aids such as baskets, and studies have shown that stone fragments removed after lithotripsy require the use of aids such as nitinol baskets to remove residual fragments resulting in prolonged operation time and increased operation costs 22 . However, some relevant meta-analysis pointed out that there was no signi cant difference in operation time between the dust removal group and the fragmentation group, considering that the time to dust the stones and the time to remove the stones were almost consistent, and the two articles concluded that the different results may be that the quality of the former articles was not high, including many conference abstracts, and this article included the latest cohort study and RCT study 27 . Exactly which surgical method is associated with shorter operative times requires more randomized trials for more standardized comparisons.…”

Section: Operation Timementioning

confidence: 99%

A Systematic Review and Meta-Analysis of Outcomes between Dusting and Fragmentation in Retrograde Intrarenal Surgery

Wen

Wang

Liu

et al. 2023

Preprint

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Objectives comparing stone-free rates and associated outcome measures between two surgical modalities of lithotripsy fragmentation and removal or spontaneous passage of dust during retrograde flexible ureteroscopy (RIRS)Methods In March 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. We only considered English articles and excluded pediatric patients. Reviews and protocols without any published data were excluded. We also excluded articles with conference abstracts and irrelevant content. We used the Cochran-Mantel-Haenszel method and random-effects models to assess inverse variances and 95% confidence intervals (CIs) for mean differences in categorical variables. The results were reported as odds ratios (ORs) and 95% CIs. Statistical significance was set at p < 0.05.Results Our final meta-analysis included nine articles, comprising two randomized controlled trials (RCTs) and seven cohort studies. The total number of patients included in these studies was 1326, and all studies used holmium laser lithotripsy. The pooled analysis of the dust and basket groups showed that the basket group had a higher stone-free rate (OR 0.6; 95% CI 0.41–0.89; p = 0.01); the dust group had a shorter operative time (WMD – 11.6 min; 95% CI – 19.56 – − 3.63; p = 0.004); and the dust group had a higher retreatment rate (OR 2.03; 95% CI 1.31–3.13; p = 0.001). There was no statistically significant difference between the two groups in terms of length of hospital stay, overall complications, or postoperative fever.Conclusions Our results showed that both procedures could be safely and effectively used for upper ureteral and renal calculi lithotripsy, the dust group had potential advantages over the basket group in terms of operation time, and the basket group had certain advantages in terms of stone-free rate and retreatment rate.

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Comparison and outcomes of dusting versus stone fragmentation and extraction in retrograde intrarenal surgery: results of a systematic review and meta-analysis

Cited by 17 publications

References 30 publications

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score–matched Analysis From the FLEXible Ureteroscopy Outcomes Registry

Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond

A Systematic Review and Meta-Analysis of Outcomes between Dusting and Fragmentation in Retrograde Intrarenal Surgery

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