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EXTRACTABLE FRAGMENT VERSUS DUSTING DURING URETEROSCOPIC LASER
LITHOTRIPSY IN CHILDREN: PROSPECTIVE RANDOMIZIED STUDY
Ahmed FAHMY, Mohamed YOUSSIF, Hitham BADAWY, Samir ORABI, Ashraf SAAD, Walid DAWOOD and Ibrahim
MOKHLES
Faculty of medicine, Alexandria University, Urology department, Alexandria, EGYPT
PURPOSE
Complete eradication of stone fragments is an important goal during stone management in children. Mode of
fragmentation employed to clear stone during uretroscopic laser lithotripsy raises concerns related with operative time,
associated morbidity and costs, especially by potential endoscope damage. The purpose of this study is to evaluate
outcomes of fragmentation into extractable pieces and stone dusting during ureteroscopic laser lithotripsy in children
MATERIAL AND METHODS
One hunderd children with ureteral stones underwent ureteroscopic holmium laser lithotripsy were prospectively
randomizied into two groups: group I with stone fragmented to dust (n=50), and group II with lithotripsy into
extractable fragments (n=50). Double-J stent was routinely indwelled in both groups. Operating time, stone free rate
and perioperative complications were compared. All patients were followed up for 3 months.
RESULTS
Mean stone volume in groups I and II were similar. Stone free rate was 98% and 96% in group I and II respectively.
Mean operating time was statistically significantly lower in group II (36 versus 28 min, P=0.0069). Minor complications
occurred in 8 cases (5 in group I and 3 in group II) in the form of hematuria and urinary tract infection. No major
complication encountered in both groups.
CONCLUSIONS
Fragmenting stones into extractable pieces has a shorter operative time compared with stone dusting with a comparable
stone free rate and complication rate. The optimal mode of ureteroscopic laser lithotripsy in children seems to be into
extractable fragments.