A Comparative Study between Dusting and Fragmentation in Intracorporeal Laser Lithotripsy in Distal Ureteric Stone

Abstract

Background: Ureteric stones commonly have an impact on the quality of life of the patient. There are many treatment choices for the condition, including medical treatment, extra-corporeal shock wave lithotripsy (ESWL), endoscopic intervention by ureteroscope (URS), or surgery (open or laparoscopic). Semi-rigid URS with laser lithotripsy is used to fragment ureteric stones, especially those in the distal ureter.Objectives: To assess the efficacy and complications of the dusting versus the fragmentation method for lower ureteric stones using holmium laser lithotripsy by analyzing intra-operative and post-operative variables.Patients and methods: One hundred and twenty patients with distal ureteric stones were included in the current study conducted in Ghazi AL-Hariri Teaching Hospital for Surgical Specialties from December 2020 to July 2022. The cases were divided into two groups: The first is the dusting group and the second is the fragmentation group. Both groups are further subdivided into the 10-15 mm and < 10 mm stone groups. The time of the operation, the rate of being stone-free, stone size, the rate of Double-J stents (DJS), and intraoperative complications were compared for the study groups. Results: the operative time was more among Group A (dusting) than Group B (fragmentation) with a statistically significant association, stone-free rate more in Group A (dusting) than Group B (fragmentation) without a statically significant Need for DJ in Group b (fragmentation) than group a (dusting) with statically significant association Regard intraoperative complication (mucosal injury, stone migration, perforation) more in group b (fragmentation) a (dusting) without any significant association. Conclusion: The dusting method resulted in fewer intraoperative complications (mucosal injury, stone migration, perforation) and a lower need for DJ insertion than the fragmentation method. However, it needed a longer operative time than the fragmentation method.