Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Evaluation of dusting versus basketing — can new technologies improve stone-free rates?

Nature Reviews Urology volume 13, pages 726–733 (2016)Cite this article

Subjects

Key Points

  • With the creation of flexible ureteroscopes with reduced calibre and holmium lasers of increased power, management of upper-tract urinary stones has changed towards ureteroscopic treatment

  • The techniques of stone dusting or basketing both have advantages and disadvantages, but ultimately a number of factors including surgeon preference, stone size and composition determine which is used

  • Further clinical trials are needed to define the role of these two ureteroscopic techniques for upper-urinary-tract stones

  • Technological developments such as rendering fragments paramagnetic, focused ultrasonic propulsion and lasers with increased power should improve stone-free rates as well as patient satisfaction

Abstract

Over the past two decades, the management of upper-tract urinary stones has dramatically changed towards an increase in the use of ureteroscopic treatment. This change has been driven by technological advances such as the creation of flexible ureteroscopes with reduced calibre (which now have digital, disposable and dual flexion capability) and holmium lasers with increased power. Two basic principles exist when treating stones ureteroscopically: either creating stone dust and small fragments (<1–2 mm) to theoretically enable spontaneous passage of the small particles or stone fragmentation that enables safe extraction of the stone pieces with a basket or grasper in an efficient manner. Each method has unique advantages and disadvantages, but, ultimately, surgeon preference, stone size, composition, location and intrarenal and/or ureteral anatomy determine which technique is used. To date, clinical trials comparing these two techniques are lacking.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Holmium laser technique for treating urinary stones.
Figure 2: The principles of treating stones ureteroscopically.

Similar content being viewed by others

References

  1. Matlaga, B., Jansen, J., Meckley, L., Byrne, T. & Lingeman, J. Treatment of ureteral and renal stones: a systematic review and meta-analysis of randomized, controlled trials. J. Urol. 188, 130–137 (2012).

    Article  Google Scholar 

  2. Sofer, M. et al. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J. Urol. 167, 31–34 (2002).

    Article  Google Scholar 

  3. Preminger, G., Assimos, D. & Lingeman, J. AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J. Urol. 173, 1991–2000 (2005).

    Article  Google Scholar 

  4. Kim, S., Kuo, R. & Lingeman, J. Percutaneous nephrolithotomy: an update. Curr. Opin. Urol. 13, 235–241 (2003).

    Article  Google Scholar 

  5. Michel, M., Trojasn, L. & Rassweiler, J. Complications in percutaneous nephrolithotomy. Eur. Urol. 51, 899–906 (2007).

    Article  Google Scholar 

  6. Hyams, E., Munver, R., Bird, V., Uberoi, J. & Shah, O. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J. Endourol. 24, 1583–1588 (2010).

    Article  Google Scholar 

  7. Cohen, J., Cohen, S. & Grasso, M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. Br. J. Urol. Int. 111, 127–131 (2012).

    Article  Google Scholar 

  8. Aboumarzouk, O., Monga, M., Kata, S., Traxer, O. & Somani, B. Flexible ureteroscopy and laser lithotripsy for stones &gt;2 cm: a systematic review and meta-analysis. J. Endourol. 25, 1257–1263 (2012).

    Article  Google Scholar 

  9. Marks, A. & Teichman, J. Lasers in clinical urology: state of the art and new horizons. World J. Urol. 25, 227–233 (2007).

    Article  Google Scholar 

  10. Teichman, J., Vassar, G. & Glickman, R. Holmium:yttrium-aluminum-garnet lithotripsy efficiency varies with stone composition. Urology 52, 392–397 (1998).

    Article  CAS  Google Scholar 

  11. Grasso, M. Experience with the holmium laser as an endoscopic lithotrite. Urology 48, 199–206 (1996).

    Article  CAS  Google Scholar 

  12. Chan, K. et al. Holmium:YAG laser lithotripsy: a dominant photothermal ablative mechanism with chemical decomposition of urinary calculi. Lasers Surg. Med. 25, 22–37 (1999).

    Article  CAS  Google Scholar 

  13. Pierre, S. & Preminger, G. Holmium laser for stone management. World J. Urol. 25, 235–239 (2007).

    Article  Google Scholar 

  14. Patel, A. P. & Knudsen, B. E. Optimizing use of the holmium: YAG laser for surgical management of urinary lithiasis. Curr. Urol. Rep. 15, 397 (2014).

    Article  Google Scholar 

  15. Hecht, S. L. & Wolf, J. Techniques for holmium laser lithotripsy of intrarenal calculi. Urology 81, 442–445 (2013).

    Article  Google Scholar 

  16. Chawla, S. N., Chang, M. F., Chang, A., Lenoir, J. & Bagley, D. H. Effectiveness of high-frequency Holmium:YAG laser stone fragmentation: the “popcorn effect”. J. Endourol. 22, 645–649 (2008).

    Article  Google Scholar 

  17. Sea, J. et al. Optimal power settings for Holmium: YAG lithotripsy. J. Urol. 187, 914–919 (2012).

    Article  Google Scholar 

  18. Traxer, O. & Thomas, A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J. Urol. 189, 580–584 (2013).

    Article  Google Scholar 

  19. Delvecchio, F. C. et al. Assessment of stricture formation with the ureteral access sheath. Urology 61, 518–522 (2003).

    Article  Google Scholar 

  20. Rapoport, D., Perks, A. & Teichman, J. Ureteral access sheath use and stenting in ureteroscopy: effect on unplanned emergency room visits and cost. J. Endourol. 21, 993–997 (2007).

    Article  Google Scholar 

  21. Rebuck, D., Macejko, A., Bhalani, V., Ramos, P. & Nadler, R. The natural history of renal stone fragments following ureteroscopy. Urology 77, 564–568 (2011).

    Article  Google Scholar 

  22. Chew, B. et al. Natural history, complications and re-Intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE Research Consortium. J. Urol. 195, 982–986 (2016).

    Article  Google Scholar 

  23. Ito, H. et al. Preoperative factors predicting spontaneous clearance of residual stone fragments after flexible ureteroscopy. Int. J. Urol. 22, 372–377 (2015).

    Article  Google Scholar 

  24. Hyams, E. S., Bruhn, A., Lipkin, M. & Shah, O. Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J. Endourol. 24, 1411–1414 (2010).

    Article  Google Scholar 

  25. Schatloff, O., Lindner, U., Ramon, J. & Winkler, H. Randomized trial of stone fragment active retrieval versus spontaneous passage during holmium laser lithotripsy for ureteral stones. J. Urol. 183, 1031–1035 (2010).

    Article  Google Scholar 

  26. Shah, O. & Humphreys, M. R. Dusting versus basketing during ureteroscopic lithotripsy—what is more efficacious? Interim analysis from a multi-centre prospective trial from the EDGE Research Consortium. AUA News 20, (2015).

  27. Chew, B. H. et al. Dusting versus basketing during ureteroscopic lithotripsy—what is more efficacious? Interim analysis from a multi-centre prospective trial from the EDGE Research Consortium [abstract]. J. Urol. 193, 261–262 (2015).

    Google Scholar 

  28. Portis, A., Laliberte, M., Drake, S., Rosenberg, M. & Bretzke, C. Intraoperative fragment detection during percutaneous nephrolithotomy: evaluation of high magnification rotational fluoroscopy combined with aggressive nephroscopy. J. Urol. 175, 162–165 (2006).

    Article  Google Scholar 

  29. Cloutier, J. et al. The glue-clot technique: a new technique description for small calyceal stone fragments removal. Urolithiasis 42, 441–444 (2014).

    Article  CAS  Google Scholar 

  30. Tracy, C. R. et al. Rendering stone fragments paramagnetic with iron-oxide microparticles improves the efficiency and effectiveness of endoscopic stone fragment retrieval. Urology 76, 1266–1270 (2010).

    Article  Google Scholar 

  31. Sorensen, M. D. et al. Focused ultrasonic propulsion of kidney stones: review and update of preclinical technology. J. Endourol. 27, 1183–1186 (2013).

    Article  Google Scholar 

  32. Bailey, M. et al. Acoustic radiation force to reposition kidney stones. J. Acoust. Soc. Am. 133, 3279 (2013).

    Article  Google Scholar 

  33. Harper, J. et al. Focused ultrasound to expel calculi from the kidney: safety and efficacy of a clinical prototype device. J. Urol. 190, 1090–1095 (2013).

    Article  Google Scholar 

  34. Shah, A. et al. Focused ultrasound to expel calculi from the kidney. J. Urol. 187, 739–743 (2012).

    Article  Google Scholar 

  35. Shah, A. et al. Novel ultrasound method to reposition kidney stones. Urol. Res. 38, 491–495 (2010).

    Article  Google Scholar 

  36. Wang, Y. et al. Determination of tissue injury thresholds from ultrasound in a porcine kidney model. J. Acoust. Soc. Am. 133, 3411 (2013).

    Article  Google Scholar 

  37. Bailey, M. et al. Ultrasonic propulsion of kidney stones: preliminary results of human feasibility study. IEEE Int. Ultrason. Symp. 511–514 (2014).

  38. Morhardt, D. R., Tracey, J., Wolf, J. & Ghani, K. R. The new Stone Age: outcomes of ureteroscopic stone dusting using a 120-watt Holmium laser [abstract]. J. Urol. 193, 580–581 (2015).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, NYU School of Medicine, 550 First Avenue, New York, 10016, New York, USA

    Brian Weiss

  2. Division of Endourology and Stone Disease, Department of Urology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, New York, 10032, New York, USA

    Ojas Shah

Authors
  1. Brian Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ojas Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors researched data for, discussed content for, wrote, reviewed and edited the article before submission.

Corresponding author

Correspondence to Ojas Shah.

Ethics declarations

Competing interests

O.S. has been a consultant and lecturer and served on the scientific advisory board for Boston Scientific. He is an Assistant Editor for the Journal of Urology and has served on the Guidelines Committee for Surgical Management of Stone Disease for the American Urological Association. He is also the Editor of a textbook for Elsevier and is a Special Government Employee for the Food and Drug Administration, USA. B.W. declares no competing interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weiss, B., Shah, O. Evaluation of dusting versus basketing — can new technologies improve stone-free rates?. Nat Rev Urol 13, 726–733 (2016). https://doi.org/10.1038/nrurol.2016.172

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2016.172

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing