Mitchell R Humphreys1, Ojas D Shah2, Manoj Monga3, Yu-Hui Chang1, Amy E Krambeck4, Roger L Sur5, Nicole L Miller6, Bodo E Knudsen7, Brian H Eisner8, Brian R Matlaga9, Ben H Chew10. 1. Mayo Clinic, Phoenix, Arizona. 2. Columbia University, New York, New York. 3. Cleveland Clinic, Cleveland, Ohio. 4. Indiana University, Indianapolis, Indiana. 5. University of California-San Diego, San Diego, California. 6. Vanderbilt University, Nashville, Tennessee. 7. Ohio State University, Columbus, Ohio. 8. Massachusetts General Hospital, Boston, Massachusetts. 9. Johns Hopkins Hospital, Baltimore, Maryland. 10. University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: ben.chew@ubc.ca.
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.
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.
Authors: Ali H Aldoukhi; Timothy L Hall; Khurshid R Ghani; Adam D Maxwell; Brian MacConaghy; William W Roberts Journal: J Endourol Date: 2018-07-13 Impact factor: 2.942
Authors: Samuel Zetumer; Scott Wiener; David B Bayne; Manuel Armas-Phan; Samuel L Washington; David T Tzou; Marshall Stoller; Thomas Chi Journal: J Endourol Date: 2019-08-20 Impact factor: 2.942
Authors: J Hogan Randall; Raphael V Carrera; Paul J Fletcher; David A Duchene; Kerri L Thurmon; Donald A Neff; Wilson R Molina Journal: World J Urol Date: 2021-01-29 Impact factor: 4.226