Urolithiasis Clinical Trial
Official title:
Dusting vs Basketing in RIRS: a Single-center Prospective Randomised Trial
The investigator aims to perform a prospective and randomized controlled trial comparing the safety and efficacy of active basket extraction of fragments and stone dusting during the RIRS.
RIRS has been widely adopted and used by urologists worldwide in the management of renal
stones due to less invasiveness and efficacy, especially in small to moderate-sized renal
stones. RIRS has several advantages over SWL for stones less than 2 cm diameter. Most
importantly, removing the stone in one session without the need for other treatment
modalities.
Furthermore, the application of RIRS has expanded to larger stones reaching up to 35 mm in
some cases,in spite of not being the first line therapy for the larger stones. RIRS has
advantages over the PCNL especially concerning complications. Namely lower or no bleeding
events and the less invasiveness of RIRS.
Options for the treatment of intrarenal stones include fragmenting the stone then extracting
large fragments using a basket or dusting the stone into very small fragments then leaving
the (dust) to pass spontaneously.
The idea of dusting in RIRS emerges as a counterpart of the originally taught fragmentation
and basketing of the stones. Aiming to reduce multiple entries and exits for the renal system
and ultimately not requiring UAS or baskets during the surgery. Thus theoretically decreasing
operative time and costs with the same SFRs, In addition to minimizing the risk of ureteral
injury .
So there is a debate amongst surgeons whether to laser the stone to dust or fragment and
retrieve intra-renal fragments. EAU guidelines on the surgical management of urolithiasis
stated that dusting strategies should be limited to the treatment of large renal stones.
Without clearly differentiating between dusting or fragmentation and basketing. Cho et al;
favored fragmentation technique especially for large renal stones because the dust in dusting
technique may affect visualization and obscure small stone fragments. But this was an opinion
and not built on a direct comparative study.
Until now, there is no consensus on how to achieve optimal stone clearance once the primary
stone is fragmented with lithotripsy. And to date, no prospective randomized study has
addressed the practice of active extraction vs. spontaneous passage
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