Comparison of dusting and fragmentation methods in the flexible ureteroscopic treatment of kidney lower calyx stones

Yıldırım, Ümit; Ezer, Mehmet; Uslu, Mehmet; Güzel, Rasim; Sarıca, Kemal

doi:10.1007/s00240-022-01399-y

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Nine studies compared dusting and fragmentation methods in RIRS for the treatment of kidney stones and upper ureteral stones. There were 7 cohort studie [ 14 – 20 ] and 2 randomized clinical trials [ 21 , 22 ]. Study characteristics are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of outcomes between dusting and fragmentation in retrograde intrarenal surgery

et al. 2023

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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 intrarenal surgery (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 fragmentation groups showed that the fragmentation 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 fragmentation group in terms of the operation time, and the fragmentation group had certain advantages in terms of stone-free rate and retreatment rate.

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Section: Resultsmentioning

confidence: 99%

“…El-Nahas [ 18 ] assessed stone clearance (SFR) with unenhanced computed tomography 2 months after surgery. Yildirim [ 14 ]assessed stone-free status using USG, KUB, and NCCT 3 months after surgery. Chen was reexamined 1 month after surgery to assess stone-free status [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis of outcomes between dusting and fragmentation in retrograde intrarenal surgery

et al. 2023

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“…However, it is generally not used alone for the treatment of kidney stones with a diameter exceeding 2 cm[ 17 , 18 ]. With advances in medical technology and accumulation of clinical experience, the efficacy of FURS for the treatment of kidney stones of 2–3 cm in diameter has become increasingly recognized[ 17 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for large kidney stones: A retrospective comparative study

Wang,

Liu,

Cao

et al. 2024

World J Clin Cases

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BACKGROUND Renal stones ranging 20–40 mm are very common in China. Although no large-sample clinical studies have confirmed the clinical efficacy and safety of this method, there is also a lack of comparative data with traditional treatment. AIM To investigate the clinical efficacy of flexible ureteroscopy (FURS) and percutaneous nephrolithotomy (PCNL) by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1 (sVCAM-1) and kidney injury molecule 1 (KIM-1) levels in patients with large kidney stones (> 2 cm in diameter). METHODS This single-center observational study was performed at a Chinese hospital between January 1, 2021, and October 30, 2023. All 250 enrolled patients were diagnosed with large kidney stones (> 2 cm) and divided into a FURS group (n = 145) and a PCNL group (n = 105) by the surgical method. The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy. The operation time, time to palinesthesia, intraoperative blood loss, drop in hemoglobin, length of hospital stay, stone clearance rate, and complications were recorded in the two groups. Preoperative and postoperative serum sVCAM-1 levels, erythrocyte sedimentation rate (ESR), urine KIM-1 levels, preoperative and postoperative pain visual analog scale (VAS) and Wisconsin quality of life questionnaire (WISQOL) scores were also documented. RESULTS All 250 eligible patients completed the follow-up. There were no significant differences in baseline characteristics between the two groups (P > 0.05). The operation time in the FURS group was significantly greater than that in the PCNL group. The time to ambulation, intraoperative blood loss, decrease in hemoglobin, and length of hospital stay were significantly lower in the FURS group than in the PCNL group. The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications. There was no significant difference in antibiotic use between the groups. Postoperative serum sVCAM-1 levels, urine KIM-1 levels, and VAS scores were lower in the FURS group than in the PCNL group, but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group. CONCLUSION FURS demonstrated superior clinical efficacy in treating large kidney stones (> 2 cm in diameter) compared PCNL. It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1, ESR, and urine KIM-1 levels, subsequent improvement of patient quality of life.

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“…Nine studies compared dusting and basket methods in RIRS for the treatment of kidney stones and upper ureteral stones. There were 7 cohort studies [12][13][14][15][16][17][18] and 2 randomized clinical trials 19,20 . Study characteristics are summarized in Table 1.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…El-Nahas assessed stone clearance (SFR) with unenhanced computed tomography 2 months after surgery16. Yildirim assessed stone free status using USG, KUB, and NCCT 3 months after surgery 12 . Chen was reexamined 1 month after surgery to assess stone-free status 13 .…”

Section: Baseline Characteristicsmentioning

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 of dusting and fragmentation methods in the flexible ureteroscopic treatment of kidney lower calyx stones

Cited by 5 publications

References 15 publications

A systematic review and meta-analysis of outcomes between dusting and fragmentation in retrograde intrarenal surgery

A systematic review and meta-analysis of outcomes between dusting and fragmentation in retrograde intrarenal surgery

Clinical efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for large kidney stones: A retrospective comparative study

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

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