Dusting versus Basketing during Ureteroscopy–Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium

Mitchell R. Humphreys, Ojas D. Shah, Manoj Monga, Yu Hui Chang, Amy Krambeck, Roger L. Sur, Nicole L. Miller, Bodo E. Knudsen, Brian H. Eisner, Brian R. Matlaga, Ben H. Chew

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: There is scant evidence in the literature to support dusting vs active basket extraction during ureteroscopy for kidney stones. We prospectively evaluated and followed patients to determine which modality produced a higher stone-free rate with the fewest complications. Materials and Methods: Members of the Endourologic Disease Group for Excellence research consortium prospectively enrolled patients with a renal stone burden ranging from 5 to 20 mm in this study. A holmium laser was used and all patients were stented postoperatively. Ureteral access sheaths were used in 100% of basketing cases while sheaths were optional when dusting. The primary study outcome was the stone-free rate at 6 weeks as determined by x-ray and ultrasound. Results: A total of 84 and 75 patients were enrolled in the basketing and dusting arms, respectively. Stones in the dusting group were significantly larger (mean ± SD stone area 96.1 ± 65.3 vs 63.3 ± 46.0 mm2, p <0.001). The stone-free rate was significantly higher in the basketing group on univariate analysis (74.3% vs 58.2%, p = 0.04) but not on multivariate analysis (1.9 OR, 95% CI 0.9–4.3, p = 0.11). In patients who underwent a basketing procedure operative time was 37.7 minutes longer than in those treated with a dusting procedure (95% CI 23.8–51.7, p <0.001). There was no statistically significant difference in complication rates, hospital readmissions or additional procedures between the groups. Conclusions: The stone-free rate was higher for active basket retrieval of fragments at short-term followup on univariate analysis but not on multivariate analysis. There was no difference in postoperative complications or procedures. The 2 techniques should be in the armamentarium of the urologist.

Original languageEnglish (US)
Pages (from-to)1272-1276
Number of pages5
JournalJournal of Urology
Volume199
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Multicenter Studies
Research
Multivariate Analysis
Ureteroscopy
Patient Readmission
Kidney Calculi
Postoperative Care
Solid-State Lasers
Operative Time
X-Rays
Outcome Assessment (Health Care)
Kidney

Keywords

  • equipment and supplies
  • kidney calculi
  • laser
  • lithotripsy
  • outcome and process assessment (health care)
  • ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

Dusting versus Basketing during Ureteroscopy–Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium. / Humphreys, Mitchell R.; Shah, Ojas D.; Monga, Manoj; Chang, Yu Hui; Krambeck, Amy; Sur, Roger L.; Miller, Nicole L.; Knudsen, Bodo E.; Eisner, Brian H.; Matlaga, Brian R.; Chew, Ben H.

In: Journal of Urology, Vol. 199, No. 5, 01.05.2018, p. 1272-1276.

Research output: Contribution to journalArticle

Humphreys, MR, Shah, OD, Monga, M, Chang, YH, Krambeck, A, Sur, RL, Miller, NL, Knudsen, BE, Eisner, BH, Matlaga, BR & Chew, BH 2018, 'Dusting versus Basketing during Ureteroscopy–Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium', Journal of Urology, vol. 199, no. 5, pp. 1272-1276. https://doi.org/10.1016/j.juro.2017.11.126
Humphreys, Mitchell R. ; Shah, Ojas D. ; Monga, Manoj ; Chang, Yu Hui ; Krambeck, Amy ; Sur, Roger L. ; Miller, Nicole L. ; Knudsen, Bodo E. ; Eisner, Brian H. ; Matlaga, Brian R. ; Chew, Ben H. / Dusting versus Basketing during Ureteroscopy–Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium. In: Journal of Urology. 2018 ; Vol. 199, No. 5. pp. 1272-1276.
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abstract = "Purpose: There is scant evidence in the literature to support dusting vs active basket extraction during ureteroscopy for kidney stones. We prospectively evaluated and followed patients to determine which modality produced a higher stone-free rate with the fewest complications. Materials and Methods: Members of the Endourologic Disease Group for Excellence research consortium prospectively enrolled patients with a renal stone burden ranging from 5 to 20 mm in this study. A holmium laser was used and all patients were stented postoperatively. Ureteral access sheaths were used in 100{\%} of basketing cases while sheaths were optional when dusting. The primary study outcome was the stone-free rate at 6 weeks as determined by x-ray and ultrasound. Results: A total of 84 and 75 patients were enrolled in the basketing and dusting arms, respectively. Stones in the dusting group were significantly larger (mean ± SD stone area 96.1 ± 65.3 vs 63.3 ± 46.0 mm2, p <0.001). The stone-free rate was significantly higher in the basketing group on univariate analysis (74.3{\%} vs 58.2{\%}, p = 0.04) but not on multivariate analysis (1.9 OR, 95{\%} CI 0.9–4.3, p = 0.11). In patients who underwent a basketing procedure operative time was 37.7 minutes longer than in those treated with a dusting procedure (95{\%} CI 23.8–51.7, p <0.001). There was no statistically significant difference in complication rates, hospital readmissions or additional procedures between the groups. Conclusions: The stone-free rate was higher for active basket retrieval of fragments at short-term followup on univariate analysis but not on multivariate analysis. There was no difference in postoperative complications or procedures. The 2 techniques should be in the armamentarium of the urologist.",
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