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    URS techniques: When to choose dusting vs. basketing

    Olivier Traxer, MDOlivier Traxer, MDWhen treating kidney stones, debate continues over the use of dusting versus basketing. In this interview, Olivier Traxer, MD, describes both methods, lists his preferred laser settings, and explains why he changed the way he uses ureteral access sheaths. Dr. Traxer is professor of urology at Sorbonne University, Hospital Tenon, Paris. He was interviewed by Urology Times Editorial Consultant Stephen Y. Nakada, MD, the Uehling Professor and founding chairman of urology at the University of Wisconsin, Madison.


    Please describe dusting and basketing.

    “Dusting” means that you produce very tiny particles when you treat stones. We don’t have a clear definition of “dust” itself. When you fragment a stone, you produce small pieces from 1 to a few mm in size. Those are fragments. But what actually constitutes “dust,” nobody knows exactly. My personal definition is the production of tiny fragments that are floating when I irrigate with 40 cm H2O pressure. Because of this low density, they’re amenable to evacuation.

    “Basketing” means that the surgeon catches stone fragments with a basket and removes them. Both dusting and fragmentation are techniques to produce pieces of stone. When you’re dusting, you expect to produce only very tiny pieces, and then that dust is supposed to evacuate. When you’re fragmenting, you expect to produce pieces but then you have to remove them with basketing.


    Of the two techniques, which do you prefer and why?

    It’s really difficult to say. I like both techniques. I make the choice based on each patient and the characteristics of each stone—composition and volume. Sometimes I prefer to dust, sometimes I prefer to fragment, and sometimes I have to do both for the same patient.


    If you’re doing dusting, how do you get the stone composition?

    The problem with the dusting technique is that you never produce only dust. You regularly produce a few small pieces—fragments. If you use a basket to remove these small pieces, then you can obtain the stone composition.

    When you’re using one technique or another, you don’t produce only dust with dusting and only fragments with fragmenting. When I’m dusting, at the end I produce a few pieces to basket and use them for my stone analysis.

    Next: Can you tell me what the typical laser settings are for dusting compared to fragmenting?

    Stephen Y. Nakada, MD
    Stephen Y. Nakada, MD, a Urology Times editorial consultant, is professor and chairman of urology at the University of Wisconsin, Madison.


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