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

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Background: 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. Materials and methods: 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). Results: 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. Conclusions: For proximal ureteral stones, the stone-free rates between the dusting and fragmentation procedures were comparable. Both techniques proved to be effective.

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