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Purpose <p>To compare operative and 30-day outcomes of dusting versus popcorning lithotripsy during flexible ureteroscopy (FURS) with flexible suction ureteral access sheaths (FANS) in a real-world multicenter study.</p> Methods <p>This prospective analysis included 704 adults from 21 centers undergoing FURS for kidney stone with FANS between August 2023 and August 2024. Patients were stratified by lasing strategy into dusting (<i>n</i> = 281) or popcorning (<i>n</i> = 423). Operative parameters, complications, and stone-free status (SFS) at 30 days—assessed by 2&#xa0;mm slice non-contrast CT scan were compared. Multivariable logistic regression identified predictors of complete clearance (no fragment).</p> Results <p>Patients in the popcorning group presented with larger and denser stones (&gt; 2&#xa0;cm: 20.7% vs. 10.7%, <i>p</i> = 0.007; median HU 1100 vs. 1051, <i>p</i> = 0.003). Operative times were consistently longer with popcorning, including lasing (17 vs. 14&#xa0;min), ureteroscopy (34 vs. 30&#xa0;min), and overall duration (50 vs. 44&#xa0;min, all <i>p</i> &lt; 0.001). Safety outcomes were comparable, although ureteric injury related to sheath placement was observed exclusively in the dusting group (6.8% vs. 0%, <i>p</i> &lt; 0.001). At 30 days, dusting demonstrated superior outcomes: complete clearance (69.4% vs. 53.9%, <i>p</i> &lt; 0.001), and lower reintervention rates (2.1% vs. 5.7%, <i>p</i> = 0.037). Multivariable analysis using sequentially adjusted models confirmed stone volume as a negative predictor of clearance (OR 0.76–0.81, <i>p</i> ≤ 0.005), while use of Thulium fiber and pulsed Thulium: YAG lasers increased odds of achieving zero residual fragments.</p> Conclusion <p>Dusting was associated with higher stone-free rates and fewer reinterventions compared with popcorning. However, laser technology, rather than lasing strategy, was the strongest predictor of outcomes, underscoring the need for individualized treatment planning.</p>

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Lasing strategy and its influence on 30-day operative outcomes in flexible ureteroscopy with FANS: inferences from a real-world prospective multicenter study by EAU-endourology and AUSET

  • 期刊论文

  • 发表日期：

    2025年10月28日

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  • Vineet Gauhar,
  • Carlo Giulioni,
  • Federico Falsetti,
  • Angelo Cafarelli,
  • Steffi Kar-Kei Yuen,
  • Khi Yung Fong,
  • Karl Tan,
  • Jia-Lun Kwok,
  • Kazumi Taguchi,
  • Mehmet Ilker Gökce,
  • Wissam Kamal,
  • Nariman Gadzhiev,
  • Vigen Malkhasyan,
  • Saeed Bin Hamri,
  • Luis Rico,
  • Pablo Contreras,
  • Yi Quan Tan,
  • Kremena Petkova,
  • Mohamed Elshazly,
  • Yiloren Tanidir,
  • Chu Ann Chai,
  • Azimdjon N. Tursunkulov,
  • Anil Shrestha,
  • Boyke Soebhali,
  • Albert El Hajj,
  • Mohamed Amine Lakmichi,
  • Tzevat Tefik,
  • Satyendra Persaud,
  • Abhishek Singh,
  • Olivier Traxer,
  • Bhaskar Somani,
  • Daniele Castellani

摘要

Purpose

To compare operative and 30-day outcomes of dusting versus popcorning lithotripsy during flexible ureteroscopy (FURS) with flexible suction ureteral access sheaths (FANS) in a real-world multicenter study.

Methods

This prospective analysis included 704 adults from 21 centers undergoing FURS for kidney stone with FANS between August 2023 and August 2024. Patients were stratified by lasing strategy into dusting (n = 281) or popcorning (n = 423). Operative parameters, complications, and stone-free status (SFS) at 30 days—assessed by 2 mm slice non-contrast CT scan were compared. Multivariable logistic regression identified predictors of complete clearance (no fragment).

Results

Patients in the popcorning group presented with larger and denser stones (> 2 cm: 20.7% vs. 10.7%, p = 0.007; median HU 1100 vs. 1051, p = 0.003). Operative times were consistently longer with popcorning, including lasing (17 vs. 14 min), ureteroscopy (34 vs. 30 min), and overall duration (50 vs. 44 min, all p < 0.001). Safety outcomes were comparable, although ureteric injury related to sheath placement was observed exclusively in the dusting group (6.8% vs. 0%, p < 0.001). At 30 days, dusting demonstrated superior outcomes: complete clearance (69.4% vs. 53.9%, p < 0.001), and lower reintervention rates (2.1% vs. 5.7%, p = 0.037). Multivariable analysis using sequentially adjusted models confirmed stone volume as a negative predictor of clearance (OR 0.76–0.81, p ≤ 0.005), while use of Thulium fiber and pulsed Thulium: YAG lasers increased odds of achieving zero residual fragments.

Conclusion

Dusting was associated with higher stone-free rates and fewer reinterventions compared with popcorning. However, laser technology, rather than lasing strategy, was the strongest predictor of outcomes, underscoring the need for individualized treatment planning.