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.
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).
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.
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.
World journal of urology. 2025 Oct 28*** epublish ***
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
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Urology Unit, Villa Igea Private Hospital, Casa di Cura Villa Igea, Ancona, 60127, Italy. ., Department of Precision and Regenerative Medicine and Ionian Area- Urology, Division of Urology, Andrology and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy., Urology Unit, Villa Igea Private Hospital, Casa di Cura Villa Igea, Ancona, 60127, Italy., Endourology Section of the European Association of Urology, Arnhem, The Netherlands., Department of Urology, Sengkang General Hospital, Singapore, Singapore., Department of Urology, Veterans Memorial Medical Center, Quezon City, Philippines., Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore., Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation., Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation., Urology Department, Specialized Medical Center, Riyadh, Saudi Arabia., Department of Urology, Hospital Alemán, Buenos Aires, Argentina., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Urology Department, Menoufia University, Shibin el Kom, Egypt., Department of Urology, Medicana Atasehir Hospital, Istanbul, Turkey., Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia., Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan., Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal., Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia., Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon., Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco., Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey., Division of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago., Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.