Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction

被引:110
作者
Matlaga, Brian R. [1 ]
Chew, Ben [2 ]
Eisner, Brian [3 ]
Humphreys, Mitchell [4 ]
Knudsen, Bodo [5 ]
Krambeck, Amy [4 ]
Lange, Dirk [2 ]
Lipkin, Michael [6 ]
Miller, Nicole L. [7 ]
Monga, Manoj [8 ]
Pais, Vernon [9 ]
Sur, Roger L. [10 ]
Shah, Ojas [11 ]
机构
[1] Johns Hopkins Med Inst, James Buchanan Brady Urol Inst, 600 North Wolfe St,Pk 221, Baltimore, MD 21287 USA
[2] Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
[3] Massachusetts Gen Hosp, Dept Urol, Boston, MA 02114 USA
[4] Mayo Clin, Dept Urol, Indianapolis, IN USA
[5] Ohio State Univ, Med Ctr, Dept Surg, Div Urol, Columbus, OH 43210 USA
[6] Duke Univ, Med Ctr, Dept Surg & Urol, Durham, NC USA
[7] Vanderbilt Univ, Sch Med, Dept Urol Surg, Nashville, TN 37212 USA
[8] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA
[9] Dartmouth Hitchcock Med Ctr, Dept Urol, Lebanon, NH 03766 USA
[10] Univ Calif San Diego, Dept Surg Urol, San Diego, CA USA
[11] NYU, Dept Urol, New York, NY USA
关键词
ureteroscopy; lithotripsy; laser; EDGE RESEARCH CONSORTIUM; HOLMIUM-YAG LASER; URINARY CALCULI; RENAL STONE; IN-VITRO; SETTINGS; RETROPULSION; EFFICIENCY; FREQUENCY; MECHANISM;
D O I
10.1089/end.2017.0641
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1 / 6
页数:6
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