Stone-breaking and retrieval strategy during retrograde intrarenal surgery

During the last 2 decades, the role of retrograde int­ rarenal surgery (RIRS) has markedly expanded as an advanced treatment modality for urinary calculi. RIRS is now considered as a first­line treatment of renal stones sized less than 20 mm regardless of stone location, stone composition, or renal anatomy because of high success rates and low morbidities [1,2]. The stone­breaking and retrieval method is one of the most interesting aspects of RIRS. Traditionally, stone retrieval with a basket after fragmentation of the stone into smaller extractable pieces was accepted as the standard step during RIRS. However, as the indication for RIRS has expanded to large and complicated stones, several technical modifications have been made to enhance the time­efficiency and surgical outcomes of RIRS. Now the term dusting is popularly used in stone surgeries such as RIRS and mini­ percutaneous nephrolithotomy. There is no clear definition of dusting, but it generally means fragmenting stones into tiny pieces or a fine powder to eliminate the necessity for stone retrieval. To realize optimal dusting, a laser setting with a low pulse power energy (0.2–0.5 J) is essential. A low pulse power laser tends to grind the stone finely rather than into large pieces because the stones are mostly broken by photothermal effects rather than by shockwave effects [3]. Although the concept of dusting in RIRS was only recently established, this technique has rapidly become popular. A recent study demonstrated interesting data as a result of a global survey. Two­thirds of more than 400 surgeons from 44 countries responded that they had already used the dusting technique during RIRS [4]. However, clinical data on whether this technique is superior to the traditional fragmentation and retrieval technique are still limited. The quality of dusting during RIRS can be affected by several factors such as stone composition, stone size, and Stone-breaking and retrieval strategy during retrograde intrarenal surgery Editorial