Flexible Ureteroscopy for Renal Stone Fragmentation: Extraction versus No Extraction

Objective: To compare the operative time and stone-free rates between dusting alone and dusting with basket extraction in patients with 15-20 mm renal calculi. Study Design: Prospective observational studyPlace and Duration of Study: This study was conducted at the Department of Urology, Al-Kafeel Hospital, 56001, Karbala, Iraq from 1st January 2024 to 31st December 2024. Methods: 164 consecutive patients were enrolled. Seventy-three patients underwent dusting with basket extraction, while 91 patients were treated with dusting alone. Stone burden were assessed using non-contrast computed tomography by measuring maximal axial diameter and calculating ellipsoid stone volume. Patients were followed for 4 weeks postoperatively. Primary outcomes were operative time and stone-free fate, while secondary outcomes included perioperative complications. Results: Mean operative time was significantly longer in the dusting with extraction group compared with the dusting-only group (72±10 vs 59±8 minutes; mean difference 13 minutes, 95% CI 10–16). The stone-free rates at 4 weeks was 91% in the extraction group and 86% in the dusting group, with an absolute difference of 5% (95% CI –4 to 13), which was not statistically significant. Complications were infrequent and minor, with no major adverse events reported. Conclusions: In patients with 15–20 mm renal calculi, laser dusting alone achieves stone-free rates comparable to dusting with basket extraction while significantly reducing operative time. The use of standardized non-contrast computed tomography-based volumetric assessment enhances the reliability of stone-burden evaluation and should be considered in future clinical trials and routine practice.