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Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months
Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to ‘dust’ and ‘pop-dust’ the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017–April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3–0.6 J and a frequency of 20–50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2–88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3–23 mm) and 21 mm (range 15–52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

Dusting, Fragmentation, Laser, Pop-dusting, Popcorn, Stone, Ureteroscopy
2194-7228
391-394
Pietropaolo, Amelia
dd6770c4-bf2e-46a9-b7a2-7bd3f9fdba56
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Whitehurst, Lily
feb002b4-5f68-46ae-baee-6fe6a1099b65
Somani, Bhaskar K
7ed77b4e-3ffc-43ef-bc61-bd1c1544518c
Pietropaolo, Amelia
dd6770c4-bf2e-46a9-b7a2-7bd3f9fdba56
Jones, Patrick
d27beb5b-0e09-4ed5-89f0-6c62421c2397
Whitehurst, Lily
feb002b4-5f68-46ae-baee-6fe6a1099b65
Somani, Bhaskar K
7ed77b4e-3ffc-43ef-bc61-bd1c1544518c

Pietropaolo, Amelia, Jones, Patrick, Whitehurst, Lily and Somani, Bhaskar K (2019) Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months. Urolithiasis, 47 (4), 391-394. (doi:10.1007/s00240-018-1076-4).

Record type: Article

Abstract

Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to ‘dust’ and ‘pop-dust’ the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017–April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3–0.6 J and a frequency of 20–50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2–88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3–23 mm) and 21 mm (range 15–52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

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Accepted/In Press date: 1 August 2018
e-pub ahead of print date: 21 August 2018
Published date: August 2019
Keywords: Dusting, Fragmentation, Laser, Pop-dusting, Popcorn, Stone, Ureteroscopy

Identifiers

Local EPrints ID: 424369
URI: http://eprints.soton.ac.uk/id/eprint/424369
ISSN: 2194-7228
PURE UUID: 14e872f2-be0b-43c1-a69c-7ce87f31b0c2

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Date deposited: 05 Oct 2018 11:36
Last modified: 15 Mar 2024 21:30

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Contributors

Author: Amelia Pietropaolo
Author: Patrick Jones
Author: Lily Whitehurst
Author: Bhaskar K Somani

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