Stone Dusting and Spontaneous Passage versus Fragmentation and Active Fragment Retrieval Using Flexible Ureteroscopy for Lower Calyceal Stones 1 to 2 cm: Comparative Study

Background: Flexible ureteroscopy (FURS) is currently the preferred treatment option for most uncomplicated renal calculi. It has been shown to be more effective than shockwave lithotripsy (SWL) for small calculi < 20 mm. We aimed to compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval using fURS for lower calyceal stones 1 to 2cm. Methods: This prospective cross-sectional study was conducted on one-hundered patients with kidney stones who were admitted to our department for retrograde intrarenal surgery (RIRS) aged above 18 years old. The patients were divided into two groups: Group A (N=50): stones were dusted using low energy and high frequency with the tip of the laser fiber was moved over the stone surface and Group B (N=50): stones were fragmented using higher energy and lower frequency and the stone was disintegrated into fragments that were extracted using a nitinol basket. Results: Operative time was significantly shorter in group A compared to group B (P value >0.001), FURS were significantly better in group B compared to group A (P value =0.022). Hospital stay, SWL, semi-rigid URS, second flexible and postoperative complications were insignificantly different between the studied groups (P value >0.05). Conclusions: FURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique had a significantly better SFR. Both techniques have comparable safety, hospital stay and requirement for secondary procedures.