Moretto Stefano, Quarà Alberto, Zorzi Federico, Bravo-Balado Alejandra, Madden Aideen, Cabrera Johan, Corrales Mariela, Candela Luigi, Doizi Steeve, Panthier Frederic, Traxer Olivier
Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France.
GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France.
BJU Int. 2025 Aug;136(2):185-197. doi: 10.1111/bju.16765. Epub 2025 May 9.
To evaluate and synthesise the existing literature on stone dust (DUST) in endourology, focusing on its definition, creation methods, and removal techniques.
A comprehensive electronic literature search was conducted using the PubMed/Medline, Web Of Science, and Embase databases to identify reports published until October 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes assessed included the definition of DUST, the method by which DUST was created, and how it was removed, evaluating both in vitro and in vivo studies. The review also assessed the efficacy of different laser technologies, including holmium-yttrium-aluminium-garnet (Ho:YAG) laser, thulium fibre laser (TFL), and pulsed thulium-YAG laser (p-Tm:YAG) laser, in generating DUST and their clinical relevance in stone management.
The systematic review identified 43 eligible studies, revealing significant variability in the definition and evaluation of DUST. Criteria for DUST ranged from sub-millimetre particle sizes to functional properties like floatability and aspiration capability. While Ho:YAG lasers remain widely used for stone dusting, emerging technologies such as TFL and p-Tm:YAG lasers have shown superior efficiency in producing finer particles and reducing retropulsion. No consensus emerged regarding the settings used by surgeons and the pre-settings provided by laser manufacturers.
Despite the widespread use of dusting techniques in endourology, a standardised definition of DUST remains lacking, with significant variability in laser settings, particle sizes, and evacuation methods. It must be clarified whether DUST should be defined as a noun-representing a distinct entity with a precise definition-or as the result of the dusting process, in which case clear criteria are needed to characterise it accurately. Establishing standardised definitions and protocols through international consensus is crucial to optimising clinical outcomes and ensuring consistency in future research.
评估并综合泌尿腔内泌尿外科领域中有关结石粉尘（DUST）的现有文献，重点关注其定义、产生方法及清除技术。
利用PubMed/Medline、科学网和Embase数据库进行全面的电子文献检索，以识别截至2024年10月发表的报告。遵循系统评价和Meta分析的首选报告项目指南来确定符合条件的研究。评估的结果包括DUST的定义、产生DUST的方法以及清除方法，同时评估体外和体内研究。该综述还评估了不同激光技术的疗效，包括钬-钇-铝-石榴石（Ho:YAG）激光、铥光纤激光（TFL）和脉冲铥-钇-铝-石榴石（p-Tm:YAG）激光在产生DUST方面的情况及其在结石治疗中的临床相关性。
该系统评价确定了43项符合条件的研究，结果显示在DUST的定义和评估方面存在显著差异。DUST的标准范围从亚毫米颗粒大小到诸如漂浮性和抽吸能力等功能特性。虽然Ho:YAG激光仍广泛用于结石粉尘化，但TFL和p-Tm:YAG激光等新兴技术在产生更细颗粒和减少结石回推方面显示出更高的效率。对于外科医生使用的参数设置以及激光制造商提供的预设参数，尚未达成共识。
尽管粉尘化技术在泌尿腔内泌尿外科中广泛应用，但仍缺乏DUST的标准化定义，在激光设置、颗粒大小和清除方法方面存在显著差异。必须明确DUST应定义为代表具有精确含义的独特实体的名词，还是应定义为粉尘化过程的结果，在这种情况下，需要明确的标准来准确描述它。通过国际共识建立标准化定义和方案对于优化临床结果和确保未来研究的一致性至关重要。
