Dusting versus basketing during ureteroscopy - Which technique is more efficacious? A prospective multi-center trial from the EDGE Research Consortium

There is scant evidence in the literature to support dusting stones vs active basket extraction during ureteroscopy for kidney stones. We sought to prospectively evaluate and follow patients to determine which modality produced a higher stone free rate with the least complications.

Members of the EDGE research consortium prospectively enrolled patients with renal stone burdens ranging from 5 to 20 mm. A holmium laser was used and all patients were stented postoperatively. Ureteral access sheaths were used in 100% of basketing patients while optional when dusting. The primary outcome was stone-free rate at 6 weeks as determined by x-ray and ultrasound.

Eighty four patients enrolled in the basketing arm and 75 patients in the dusting arm. Stones in the dusting group were significantly larger (mean stone area 96.1±65.3 mm2 vs 63.3 ±46.0 mm2, p<0.001). The stone free rate was significantly higher in the basketing group (74.3% vs 58.2%, p=0.04) on univariate analysis but not on multivariate analysis (1.9 OR95% CI: 0.9-4.3, p=0.11). Patients who underwent a basketing procedure had 37.7 minutes longer operative time compared to those with dusting procedure (95%CI: 23.8-51.7, p<0.001). There was no statistically significant difference in complication rates, readmission or additional procedure between groups.

The stone free rate is higher for active basket retrieval of fragments at short-term follow-up on univariate analysis, but not on multivariate analysis. There was no difference in postoperative complications or procedures and both techniques should be in the urologist's armamentarium.

The Journal of urology. 2017 Dec 15 [Epub ahead of print]

M R Humphreys, O D Shah, M Monga, Y H Chang, A E Krambeck, R L Sur, N L Miller, B E Knudsen, B H Eisner, B R Matlaga, B H Chew

Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Mayo Clinic, Phoenix, AZ., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Columbia University, New York, NY., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; The Cleveland Clinic, Cleveland, OH., Mayo Clinic, Phoenix, AZ., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Indiana University, Indianapolis, IN., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; University of California San Diego, CA., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Vanderbilt University, Nashville, TN., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; The Ohio State University, Columbus, OH., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Massachusetts General Hospital, Boston, MA., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; Johns Hopkins Hospital, Baltimore, MD., Endourologic Disease Group for Excellence (EDGE) Research Consortium Member; University of British Columbia, Vancouver, BC. Electronic address: http://www.endoedge.net.

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