Presented by: Russell Becker MD PhD
University of Michigan Medicine

Introduction

Dusting technique for ureteroscopy (URS) laser lithotripsy has become popular, but there remains a knowledge gap about how often it is performed compared to fragmentation with basketing. Prior studies of outcomes for dusting vs. fragmentation are from expert single centers and may not reflect real-world practice. We assessed practice patterns and outcomes of the two techniques in Michigan.

Materials

Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry, we identified all single-stage cases of URS laser lithotripsy performed for renal stones between 2016-2022. Data was collected by independent abstractors at each practice using standardized definitions. Stone-free rate (SFR) was defined as zero fragments on imaging reports (ultrasound, x-ray, CT scan) within 60 days. We assessed urologist-level utilization of dusting vs. fragmentation/basketing. Using multivariable regression we assessed the association of each technique with stone-free rate and 30-day postoperative emergency department (ED) visits accounting for patient, stone, and surgical characteristics.

Results

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Among 4,772 ureteroscopy procedures for renal stones performed by 230 surgeons across 34 practices, 2,838 (59%) were performed with a dusting technique. Significant variation in use of dusting was observed across urologists (0-100%, p<0.001) (Figure 1A). Dusting was used more frequently for larger stones (median [IQR]: 9mm [7-13] vs 8mm [6-11], p<0.001) and stones in multiple locations (30% vs. 20%, p<0.001). Ureteral access sheaths (55% vs 72%, p<0.001) and post-operative stents (79% vs 86%, p<0.001) were used less frequently with dusting. Dusting approach was associated with higher ED visits on multivariable analysis (OR 1.4, 95% CI 1.1-1.8, p=0.006). Post-operative imaging was performed in 48% of patients; SFR was lower with dusting (OR 0.6, 95% CI 0.5-0.7, p<0.001) (Figure 1B).

Conclusion

Six of ten patients with renal stones undergoing URS are treated with a dusting technique in Michigan. Real-world practice indicates dusting is associated with higher post-operative ED visits and lower stone-free rates.

Funding

MUSIC is funded by Blue Cross Blue Shield of Michigan.

Lead Authors

Alex Zhu, DO
University of Michigan Medicine

Co-Authors

Andrew Higgins, MD
University of Michigan Medicine

Monica Van Til,
University of Michigan Medicine

Stephanie Daignault-Newton,
University of Michigan Medicine

Sung Yong Cho, MD
University of Michigan Medicine

Richard Sarle, MD
Sparrow Hospital Urology

Eric Stockall, MD
Capital Urological Associates

Casey Dauw, MD
University of Michigan Medicine

Khurshid Ghani, MBChB
University of Michigan Medicine