Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction
- 1 January 2018
- journal article
- review article
- Published by Mary Ann Liebert Inc in Journal of Endourology
- Vol. 32 (1), 1-6
- https://doi.org/10.1089/end.2017.0641
Abstract
Introduction: Ureteroscopic laser lithotripsy is becoming the most commonly utilized treatment for patients with urinary calculi. The Holmium:YAG (yttrium aluminum garnet) laser is integral to the operation and is the preferred flexible intracorporeal lithotrite. In recent years, there has been increasing interest in examining the effect of varying the laser settings on the effectiveness of stone treatment. Herein, we review the two primary laser treatment approaches: dusting and fragmentation with extraction. Methods: We reviewed PubMed and MEDLINE databases from January 1976 through January 2017. All authors participated in the development of consensus definitions of dusting and fragmentation with extraction. The review protocol adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. Results: When the Holmium:YAG laser is used to treat stones, there are two parameters that can be adjusted: power (J) and frequency (Hz). In one treatment paradigm, which became termed “fragmentation with extraction,” laser settings that relied on high energy and low frequency were used. Another paradigm, which became termed “dusting,” utilized low energy and high frequency settings, which had the effect of breaking off exceedingly small fragments from the stone. Conclusions: Both dusting and fragmentation with extraction approaches to ureteroscopic stone treatment are effective. In fact, there is little evidence that one approach is better than the other. However, each does have relative advantages and disadvantages, which should be considered. Although dusting tends to be associated with shorter procedure times and a lower risk of ureteral damage, this approach may place the patient at increased risk for future stone events should all of the resultant debris not be expelled from the collecting system. The active removal associated with fragmentation with extraction, in contrast, may provide for a more complete initial stone clearance.Keywords
This publication has 25 references indexed in Scilit:
- Variable Pulse Duration From a New Holmium:YAG Laser: The Effect on Stone Comminution, Fiber Tip Degradation, and Retropulsion in a Dusting ModelUrology, 2017
- PD18-10 DUSTING VS BASKETING DURING URETEROSCOPIC LITHOTRIPSY—WHAT IS MORE EFFICACIOUS? FINAL RESULTS FROM THE EDGE RESEARCH CONSORTIUMJournal of Urology, 2016
- PD18-09 SHOULD STONE REMOVAL BE DONE AFTER STONE FRAGMENTATION IN THE MANAGEMENT OF UPPER URINARY SYSTEM STONES?Journal of Urology, 2016
- In vitro fragmentation efficiency of holmium: yttrium‐aluminum‐garnet (YAG) laser lithotripsy – a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diametersBJU International, 2014
- Optimal Power Settings for Holmium:YAG LithotripsyJournal of Urology, 2012
- Effect of Pulse Energy, Frequency and Length on Holmium:Yttrium-Aluminum-Garnet Laser Fragmentation Efficiency in Non-Floating Artificial Urinary CalculiJournal of Endourology, 2010
- Effect of Holmium:YAG Laser Pulse Width on Lithotripsy Retropulsion in VitroJournal of Endourology, 2005
- Holmium: YAG Lithotripsy: Photothermal MechanismJournal of Endourology, 1999
- Holmium:YAG laser lithotripsy: A dominant photothermal ablative mechanism with chemical decomposition of urinary calculiLasers in Surgery and Medicine, 1999
- Evaluation of Retropulsion Caused by Holmium: YAG Laser with Various Power Settings and FibersJournal of Endourology, 1998