A Systematic Review and Meta-Analysis of Outcomes between Dusting and Fragmentation in Retrograde Intrarenal Surgery

Objectives: comparing stone-free rates and associated outcome measures between two surgical modalities of lithotripsy fragmentation and removal or spontaneous passage of dust during retrograde flexible ureteroscopy (RIRS) Methods: In March 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. We only considered English articles and excluded pediatric patients. Reviews and protocols without any published data were excluded. We also excluded articles with conference abstracts and irrelevant content. We used the Cochran-Mantel-Haenszel method and random-effects models to assess inverse variances and 95% confidence intervals (CIs) for mean differences in categorical variables. The results were reported as odds ratios (ORs) and 95% CIs. Statistical significance was set at p < 0.05. Results: Our final meta-analysis included nine articles, comprising two randomized controlled trials (RCTs) and seven cohort studies. The total number of patients included in these studies was 1326, and all studies used holmium laser lithotripsy. The pooled analysis of the dust and basket groups showed that the basket group had a higher stone-free rate (OR 0.6; 95% CI 0.41–0.89; p = 0.01); the dust group had a shorter operative time (WMD – 11.6 min; 95% CI – 19.56 – − 3.63; p = 0.004); and the dust group had a higher retreatment rate (OR 2.03; 95% CI 1.31–3.13; p = 0.001). There was no statistically significant difference between the two groups in terms of length of hospital stay, overall complications, or postoperative fever. Conclusions: Our results showed that both procedures could be safely and effectively used for upper ureteral and renal calculi lithotripsy, the dust group had potential advantages over the basket group in terms of operation time, and the basket group had certain advantages in terms of stone-free rate and retreatment rate.