Objective To compare the dusting versus fragmentation modes with Thulium fibre laser (TFL) in Retrograde Intrarenal Surgery (RIRS) for upper tract stones using the same fixed low power settings in both the arms. Primary objective was to compare stone free rate and secondary objectives were to compare mean operating times, hospital stay duration, complication rates, need for secondary procedures, laser efficacy. Materials and methods A prospective randomised trial, with patients having proximal ureteral or renal stones of 10-20 mm size and planned for RIRS was done at a single institute. Total of 60 consecutively admitted patients with signed consent were included for randomization with 30 patients in each arm of dusting and fragmentation modes. Results Median age in dusting and fragmentation arms of 41.5 and 45.5 years, median stone size of 10.45 and 12.25 mm, median stone volume of 351.6 and 490.7 mm3 and median stone density of 1263.5 HU in both arms with comparable hospital stay of median of 2 days in both arms. Lasing time was significantly lesser in the Fragmentation group (20.5 min - IQR 15.12-31.62) than in dusting group (34.25 min, IQR 26.62-38.62), p <0.001. Higher ablation speed for fragmentation mode (0.405 mm3/sec, IQR 0.337-0.635) than dusting mode (0.17 mm3/sec, IQR 0.135-0.325), p <0.001. Stone free rates and complication rates were comparable in both the arms. Conclusion TFL in fragmentation mode has shorter lasing times and better laser efficacy than dusting mode with comparable minimal complications, stone free rates and hospital stay duration.

中文翻译：

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前瞻性随机对照试验，比较逆行肾内手术中使用铥光纤激光器的除尘与碎裂。

目的 比较双臂相同固定低功率设置下逆行肾内手术 (RIRS) 中铥光纤激光 (TFL) 的除尘模式与碎裂模式。主要目的是比较无结石率，次要目的是比较平均手术时间、住院时间、并发症发生率、二次手术的需要、激光疗效。材料和方法 一项前瞻性随机试验在同一机构进行，受试者患有 10-20 毫米近端输尿管或肾结石并计划进行 RIRS。总共 60 名连续入院并签署同意书的患者被纳入随机分组，每组 30 名患者采用除尘和碎片模式。结果 除尘组和碎裂组的中位年龄分别为 41.5 和 45.5 岁，中位结石尺寸为 10.45 和 12.25 mm，中位结石体积为 351.6 和 490.7 mm3，中位结石密度为 1263.5 HU，可比住院时间中位为 2 天双臂之中。碎裂组的激射时间（20.5 分钟 - IQR 15.12-31.62）明显短于喷粉组（34.25 分钟，IQR 26.62-38.62），p <0.001。碎片模式的烧蚀速度（0.405 mm3/秒，IQR 0.337-0.635）高于除尘模式（0.17 mm3/秒，IQR 0.135-0.325），p <0.001。两组的无结石率和并发症率相当。结论 碎裂模式 TFL 比喷粉模式具有更短的激光时间和更好的激光疗效，且并发症、无结石率和住院时间相当。