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Observational Study
. 2018 May;199(5):1272-1276.
doi: 10.1016/j.juro.2017.11.126. Epub 2017 Dec 16.

Dusting versus Basketing during Ureteroscopy-Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium

Mitchell R Humphreys  1 , Ojas D Shah  2 , Manoj Monga  3 , Yu-Hui Chang  1 , Amy E Krambeck  4 , Roger L Sur  5 , Nicole L Miller  6 , Bodo E Knudsen  7 , Brian H Eisner  8 , Brian R Matlaga  9 , Ben H Chew  10
Affiliations
Observational Study

Dusting versus Basketing during Ureteroscopy-Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium

Mitchell R Humphreys et al. J Urol. 2018 May.

Abstract

Purpose: There is scant evidence in the literature to support dusting vs active basket extraction during ureteroscopy for kidney stones. We prospectively evaluated and followed patients to determine which modality produced a higher stone-free rate with the fewest complications.

Materials and methods: Members of the Endourologic Disease Group for Excellence research consortium prospectively enrolled patients with a renal stone burden ranging from 5 to 20 mm in this study. A holmium laser was used and all patients were stented postoperatively. Ureteral access sheaths were used in 100% of basketing cases while sheaths were optional when dusting. The primary study outcome was the stone-free rate at 6 weeks as determined by x-ray and ultrasound.

Results: A total of 84 and 75 patients were enrolled in the basketing and dusting arms, respectively. Stones in the dusting group were significantly larger (mean ± SD stone area 96.1 ± 65.3 vs 63.3 ± 46.0 mm2, p <0.001). The stone-free rate was significantly higher in the basketing group on univariate analysis (74.3% vs 58.2%, p = 0.04) but not on multivariate analysis (1.9 OR, 95% CI 0.9-4.3, p = 0.11). In patients who underwent a basketing procedure operative time was 37.7 minutes longer than in those treated with a dusting procedure (95% CI 23.8-51.7, p <0.001). There was no statistically significant difference in complication rates, hospital readmissions or additional procedures between the groups.

Conclusions: The stone-free rate was higher for active basket retrieval of fragments at short-term followup on univariate analysis but not on multivariate analysis. There was no difference in postoperative complications or procedures. The 2 techniques should be in the armamentarium of the urologist.

Keywords: equipment and supplies; kidney calculi; laser; lithotripsy; outcome and process assessment (health care); ureteroscopy.

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