Laser lithotripsy using dusting technique (low energy, high frequency) for symptomatic upper urinary tract stones

A Ashmawy,I R Saad,M Khedr,A Kassem,S Zamel

doi:10.1186/s12301-021-00259-2

A Ashmawy, I R Saad + Show 3 more

Open Access

https://doi.org/10.1186/s12301-021-00259-2

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Abstract

BackgroundA prospective study to assess the feasibility of stone dusting technique (low energy and high frequency) during laser lithotripsy in symptomatic upper urinary tract |(UUT) stones.MethodsSixty patients with symptomatic single or multiple UUT stones less than 3 cm in diameter were included. Patients with coagulation disorders and active UTIs were excluded. All patients were clinically evaluated and underwent non-contrast spiral CT (NCSCT) to detect stone site, size, number, Hounsfield unit. A rigid or flexible ureteroscope was used with stone dusting using the Ho: YAG laser at low-energy and high-frequency (0.5 J & 20 Hz) set. Operative and fluoroscopy time, total energy delivered, type of stent, hospitalization time, complications and its grade, and stone-free rate using NCSCT after 4 weeks were recorded.ResultsThe mean stone size ± SD (range) was 1.55 ± 0.55 (0.5–3) cm; out of sixty patients (50 with single stone and 10 with multiple stones), fifty-five patients were stone-free at 4 weeks. Complications had occurred in 11 patients (eight with grade I, one with grade II, and two with grade IIIa) according to Clavien–Dindo grading of surgical complications. Stone size was the only parameter which correlated significantly with stone-free rate. No significant correlation was found between incidence of complications and other parameters (stone size, site, BMI, age and operative time).ConclusionsStone dusting technique is feasible, safe and effective in management of UUT stones.

Highlights

A prospective study to assess the feasibility of stone dusting technique during laser lithotripsy in symptomatic upper urinary tract |(UUT) stones
2 Methods This is a prospective study aiming at the assessment of safety and efficacy of ureteroscopy (URS) and laser lithotripsy (LL) with dusting technique in the management of upper urinary tract stones in sixty patients done at The Urology Department, during the period between July 2017 and February 2018. (Hospital name is blinded for peer review.)
3 Results Sixty patients were included in this study to evaluate the safety and efficacy of URS and LL using stone dusting technique for upper urinary tract stones

Summary

Introduction

A prospective study to assess the feasibility of stone dusting technique (low energy and high frequency) during laser lithotripsy in symptomatic upper urinary tract |(UUT) stones. Ureterorenoscope is a less invasive modality for treatment of ureteric and renal stones. It may be used antegrade or retrograde [1]. Laser settings or techniques are an important issue of research as with increased pulse energy many disadvantages appear. Stone dusting is to convert stone to tiny fragments or dust by decreasing energy and varying frequency to allow these tiny fragments to pass spontaneously. Fragment size is a challenging problem to urologists as it correlates with or affects stone-free rates (SFRs), as small fragment size results in high SFRs [4, 5]. Stone retropulsion or migration increases with high energy

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