title: Extractable fragment versus dusting during ureteroscopic laser lithotripsy in children: Prospective randomized study.
abstract: OBJECTIVE
  Complete eradication of stone fragments is an important goal during stone management in children. The mode of fragmentation employed to clear stones during ureteroscopic laser lithotripsy raises concerns related to operative time, associated morbidity, costs, and especially potential endoscope damage. The purpose of this study was to evaluate the outcomes of fragmentation into extractable pieces and stone dusting during ureteroscopic laser lithotripsy in children.
  
  
  METHODS
  One hundred children with ureteral stones undergoing ureteroscopic holmium laser lithotripsy were prospectively randomized into two groups: group I in which stones were fragmented to dust (n = 50), and group II in which lithotripsy resulted in extractable fragments (n = 50). Different Holmium laser settings were applied during ureteroscopic lithotripsy for each group: low power (500 mJ) and high frequency (12-15 Hz) for lithotripsy to dust. High power (1000-1500 mJ) and reduced frequency (8-10 Hz) for lithotripsy to extractable fragments. The fragmentation time, operating time, stone-free rate, and perioperative complications were compared (Figure).
  
  
  RESULTS
  The mean age of the patients was 6.8 (1-12) years and 8.2 (1-15) years, in groups I and II respectively. The mean fragmentation time and operating time were statistically significantly lower in group II (p = 0.008 and 0.0069 respectively). Minor complications occurred in eight cases (5 in group I and 3 in group II) in the form of hematuria and urinary tract infection. No major complications were encountered in either groups.
  
  
  CONCLUSIONS
  Fragmenting stones into extractable pieces has a significantly shorter fragmentation time and operative time than stone dusting, with similar stone-free and complication rates. Ureteroscopic laser lithotripsy treatment resulting in extractable fragments seems to be an effective and time-saving procedure in children.
authors.affiliation: Department of Urology, Alexandria University, Alexandria, Egypt. Electronic address: drahmedfahmy@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fahmy
authors.affiliation: Department of Urology, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Youssif
authors.affiliation: Department of Urology, Alexandria University, Alexandria, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Rhashad
authors.affiliation: Department of Urology, Alexandria University, Alexandria, Egypt.
authors.forename: Samir
authors.initials: S
authors.lastname: Orabi
authors.affiliation: Department of Urology, Alexandria University, Alexandria, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mokless
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy
keywords: Children; Dusting; Laser lithotripsy