A prospective randomized trial comparing dusting and fragmentation techniques using Holmium:YAG laser for pediatric ureteral stones

Background: As occurrence rates of pediatric ureteral stones have increased, evaluation of optimal treatment modalities has become imperative. This study’s primary goal is to compare outcomes between dusting and fragmentation techniques using Holmium:YAG (Ho:YAG) laser lithotripsy in children with ureteral stones. Methods: A prospective randomized study was conducted at AswanUniversity Hospitals fromJune 2023 to December 2024. One hundred children, under the age of 18, with single,mid- or distal, ureteral stones (5–20 mm) were randomized into two groups. Group A received laser dusting (0.2–0.6 J, 20–40 Hz), while Group B received fragmentation (0.8–1.5 J, 10–15 Hz), both using a 200-ìm fiber. Stone-free rate (SFR), operative time, complications, and other outcomes were evaluated. Results: Demographics, laboratory parameters, stone size, and location were similar across groups. Group B had a significantly longer operative time but demonstrated a higher SFR (86% vs. 66%). Basket use was universal in the fragmentation Group (B) and was the only independent predictor of stone-free status (p = 0.035). Rates of complication, retreatment, and ureteral injury did not differ significantly between the two groups. Conclusions: While both techniques are safe and effective in pediatric ureteroscopic lithotripsy, fragmentation achieves a higher SFR at the cost of longer operative time and mandatory basket use. As the dusting setting offers shorter procedure times, both settings may be suitable for selected cases depending on clinical factors such as septic status.