Pd28-08 ureteroscopy dusting versus fragmentation/basketing for treating renal stones: real world utilization and outcomes

You have accessJournal of UrologyCME1 Apr 2023PD28-08 URETEROSCOPY DUSTING VERSUS FRAGMENTATION/BASKETING FOR TREATING RENAL STONES: REAL WORLD UTILIZATION AND OUTCOMES Alex Zhu, Russell E.N. Becker, Andrew M. Higgins, Monica S. Van Til, Stephanie Daignault-Newton, Sung Yong Cho, Richard C. Sarle, Eric R. Stockall, Rabia Martin, Bronson Conrado, Golena Fernandez Moncaleano, Casey A. Dauw, Khurshid R. Ghani, and FOR the Michigan Urological Surgery Improvement Collaborative Alex ZhuAlex Zhu More articles by this author , Russell E.N. BeckerRussell E.N. Becker More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Monica S. Van TilMonica S. Van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Richard C. SarleRichard C. Sarle More articles by this author , Eric R. StockallEric R. Stockall More articles by this author , Rabia MartinRabia Martin More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and FOR the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 dusting vs. fragmentation/basketing are from expert single centers and may not reflect real-world practice. We assessed practice patterns and outcomes of the two techniques in Michigan. METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) 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 practice and urologist-level utilization of dusting vs. fragmentation/basketing. We compared characteristics of patients. Using multivariable regression we assessed the association of each technique with 30-day postoperative emergency department (ED) visits accounting for patient, stone, and surgical characteristics. RESULTS: 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 practices (3-99%, p<0.001) and urologists (0-100%, p<0.001) (Figure 1). Utilization was greatest in larger practices. 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. Post-operative imaging was performed in 48% of patients; SFR was lower with dusting (41% vs 57%, p<0.001). Dusting was associated with higher ED visits on multivariable analysis (OR 1.4, 95% CI 1.1-1.8, p=0.006). CONCLUSIONS: Six of ten patients with renal stones undergoing URS are treated with a dusting technique in Michigan. Our data suggests dusting is more frequently used in larger practices which could be related to access of high-power lasers. Real-world practice indicates dusting is associated with more post-operative ED visits. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e821 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Zhu More articles by this author Russell E.N. Becker More articles by this author Andrew M. Higgins More articles by this author Monica S. Van Til More articles by this author Stephanie Daignault-Newton More articles by this author Sung Yong Cho More articles by this author Richard C. Sarle More articles by this author Eric R. Stockall More articles by this author Rabia Martin More articles by this author Bronson Conrado More articles by this author Golena Fernandez Moncaleano More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author FOR the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...