Ureteroscopic Laser Lithotripsy

A Review of Dusting vs Fragmentation with Extraction

Brian R. Matlaga, Ben Chew, Brian Eisner, Mitchell Humphreys, Bodo Knudsen, Amy Krambeck, Dirk Lange, Michael Lipkin, Nicole L. Miller, Manoj Monga, Vernon Pais, Roger L. Sur, Ojas Shah

Research output: Contribution to journalReview article

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Endourology
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Laser Lithotripsy
Lasers
Solid-State Lasers
Holmium
Urinary Calculi
Therapeutics
PubMed
MEDLINE
Meta-Analysis
Consensus
Databases

Keywords

  • laser
  • lithotripsy
  • ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

Ureteroscopic Laser Lithotripsy : A Review of Dusting vs Fragmentation with Extraction. / Matlaga, Brian R.; Chew, Ben; Eisner, Brian; Humphreys, Mitchell; Knudsen, Bodo; Krambeck, Amy; Lange, Dirk; Lipkin, Michael; Miller, Nicole L.; Monga, Manoj; Pais, Vernon; Sur, Roger L.; Shah, Ojas.

In: Journal of Endourology, Vol. 32, No. 1, 01.01.2018, p. 1-6.

Research output: Contribution to journalReview article

Matlaga, BR, Chew, B, Eisner, B, Humphreys, M, Knudsen, B, Krambeck, A, Lange, D, Lipkin, M, Miller, NL, Monga, M, Pais, V, Sur, RL & Shah, O 2018, 'Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction', Journal of Endourology, vol. 32, no. 1, pp. 1-6. https://doi.org/10.1089/end.2017.0641
Matlaga, Brian R. ; Chew, Ben ; Eisner, Brian ; Humphreys, Mitchell ; Knudsen, Bodo ; Krambeck, Amy ; Lange, Dirk ; Lipkin, Michael ; Miller, Nicole L. ; Monga, Manoj ; Pais, Vernon ; Sur, Roger L. ; Shah, Ojas. / Ureteroscopic Laser Lithotripsy : A Review of Dusting vs Fragmentation with Extraction. In: Journal of Endourology. 2018 ; Vol. 32, No. 1. pp. 1-6.
@article{78b50fcaaebf4622b956b64965fd4587,
title = "Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction",
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 = "laser, lithotripsy, ureteroscopy",
author = "Matlaga, {Brian R.} and Ben Chew and Brian Eisner and Mitchell Humphreys and Bodo Knudsen and Amy Krambeck and Dirk Lange and Michael Lipkin and Miller, {Nicole L.} and Manoj Monga and Vernon Pais and Sur, {Roger L.} and Ojas Shah",
year = "2018",
month = "1",
day = "1",
doi = "10.1089/end.2017.0641",
language = "English (US)",
volume = "32",
pages = "1--6",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "1",

}

TY - JOUR

T1 - Ureteroscopic Laser Lithotripsy

T2 - A Review of Dusting vs Fragmentation with Extraction

AU - Matlaga, Brian R.

AU - Chew, Ben

AU - Eisner, Brian

AU - Humphreys, Mitchell

AU - Knudsen, Bodo

AU - Krambeck, Amy

AU - Lange, Dirk

AU - Lipkin, Michael

AU - Miller, Nicole L.

AU - Monga, Manoj

AU - Pais, Vernon

AU - Sur, Roger L.

AU - Shah, Ojas

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - laser

KW - lithotripsy

KW - ureteroscopy

UR - http://www.scopus.com/inward/record.url?scp=85040925410&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040925410&partnerID=8YFLogxK

U2 - 10.1089/end.2017.0641

DO - 10.1089/end.2017.0641

M3 - Review article

VL - 32

SP - 1

EP - 6

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 1

ER -