The manuscript by Matlaga et al titled "Ureteroscopic Laser Lithotripsy: A Review of Dusting Versus Fragmentation With Extraction" was first intended for a meta-analysis publication, but because limited data published, it became an interesting review article focused in the current debate about which of the so described laser urinary lithotripsy "Fragmentation with Extraction" and "Dusting" techniques is better. Authors do an effort to homologize terminology and nomenclature and list the most efficient energy settings used in clinical scenario on the "Fragmentation with Extraction" [(Frequency 12-15 Hz (< 30 watt laser) >50Hz (100/120 watt laser) / Energy 0.2-0.4J)] and "Dusting" (Frequency 6-10 Hz / Energy 1.0-1.2J), their advantages and disadvantages. They found not significant differences in stone free rates, operative time and complication rates among the current small published data available, when comparing both laser lithotripsy techniques. They also state that discussions appear to be limited to flexible ureteroscopic stone treatment. As the "Dusting" laser technique has gained popularity in about 67% according with a recent worldwide survey and the limited data published, to design randomized clinical trials under guidance of the Clinical Research Office of the Endourological Society (CROES) would be a good option. Going back to basic science is recommendable. The implementation of the Translational Medicine would minimize the "divorce" existing between basic science and clinic scenario with improvements in laser lithotripsy. To include the study of the Laser physics in the curriculum and hand-on laboratory sessions on this issue are highly recommended in urological academic centers. Laser lithotripsy should be a very dynamic process going from "Fragmentation with Extraction" to "Dusting" and vice versa and in an individual manner. Further Research must be done in order to compare the two laser techniques and determine in which scenario, each of them offers the best option for our patients.
Journal of endourology. 2017 Nov 12 [Epub ahead of print]
Joel Gustavo Gómez-Núñez
Universidad de Guadalajara CUCS, Profesor Urologìa, Guadalajara, Jalisco, Mexico.