Abstract：
OBJECTIVE: During endoscopic stone surgery, Holmium:YAG (Ho:YAG) and Thulium Fiber Laser (TFL) technologies allow to pulverize urinary stones into fine particles, ie DUST. Yet, currently there is no consensus on the exact definition of DUST. This review aimed to define stone DUST and Clinically Insignificant Residual Fragments (CIRF).
METHODS: Embase, MEDLINE (PubMed) and Cochrane databases were searched for both in vitro and in vivo articles relating to DUST and CIRF definitions, in November 2023, using keyword combinations: \"dust\", \"stones\", \"urinary calculi\", \"urolithiasis\", \"residual fragments\", \"dusting\", \"fragments\", \"lasers\" and \"clinical insignificant residual fragments\".
RESULTS: DUST relates to the fine pulverization of urinary stones, defined in vitro as particles spontaneously floating with a sedimentation duration ≥ 2 sec and suited for aspiration through a 3.6Fr-working channel (WC) of a flexible ureteroscope (FURS). Generally, an upper size limit of 250 µm seems to agree with the definition of DUST. Ho:YAG with and without \"Moses Technology\", TFL and the recent pulsed-Thulium:YAG (pTm:YAG) can produce DUST, but no perioperative technology can currently measure DUST size. The TFL and pTm:YAG achieve better dusting compared to Ho:YAG. CIRF relates to residual fragments (RF) that are not associated with imminent stone-related events: loin pain, acute renal colic, medical or interventional retreatment. CIRF size definition has decreased from older studies based on Shock Wave Lithotripsy (SWL) (≤ 4 mm) to more recent studies based on FURS (≤ 2 mm) and Percutaneous Nephrolithotomy(PCNL) (≤ 4 mm). RF ≤ 2 mm are associated with lower stone recurrence, regrowth and clinical events rates. While CIRF should be evaluated postoperatively using Non-Contrast Computed Tomography(NCCT), there is no consensus on the best diagnostic modality to assess the presence and quantity of DUST.
CONCLUSIONS: DUST and CIRF refer to independent entities. DUST is defined in vitro by a stone particle size criteria of 250 µm, translating clinically as particles able to be fully aspirated through a 3.6Fr-WC without blockage. CIRF relates to ≤ 2 RF on postoperative NCCT.
METHODS: Embase, MEDLINE (PubMed) and Cochrane databases were searched for both in vitro and in vivo articles relating to DUST and CIRF definitions, in November 2023, using keyword combinations: \"dust\", \"stones\", \"urinary calculi\", \"urolithiasis\", \"residual fragments\", \"dusting\", \"fragments\", \"lasers\" and \"clinical insignificant residual fragments\".
RESULTS: DUST relates to the fine pulverization of urinary stones, defined in vitro as particles spontaneously floating with a sedimentation duration ≥ 2 sec and suited for aspiration through a 3.6Fr-working channel (WC) of a flexible ureteroscope (FURS). Generally, an upper size limit of 250 µm seems to agree with the definition of DUST. Ho:YAG with and without \"Moses Technology\", TFL and the recent pulsed-Thulium:YAG (pTm:YAG) can produce DUST, but no perioperative technology can currently measure DUST size. The TFL and pTm:YAG achieve better dusting compared to Ho:YAG. CIRF relates to residual fragments (RF) that are not associated with imminent stone-related events: loin pain, acute renal colic, medical or interventional retreatment. CIRF size definition has decreased from older studies based on Shock Wave Lithotripsy (SWL) (≤ 4 mm) to more recent studies based on FURS (≤ 2 mm) and Percutaneous Nephrolithotomy(PCNL) (≤ 4 mm). RF ≤ 2 mm are associated with lower stone recurrence, regrowth and clinical events rates. While CIRF should be evaluated postoperatively using Non-Contrast Computed Tomography(NCCT), there is no consensus on the best diagnostic modality to assess the presence and quantity of DUST.
CONCLUSIONS: DUST and CIRF refer to independent entities. DUST is defined in vitro by a stone particle size criteria of 250 µm, translating clinically as particles able to be fully aspirated through a 3.6Fr-WC without blockage. CIRF relates to ≤ 2 RF on postoperative NCCT.
摘要：
目的：在内镜取石手术中，钬：YAG（Ho：YAG）和Thulium光纤激光（TFL）技术可以将尿路结石粉碎成细颗粒，ieDUST.然而，目前对DUST的确切定义没有共识。这篇综述旨在定义结石粉尘和临床上无意义的残留碎片（CIRF）。
方法：Embase，在MEDLINE(PubMed)和Cochrane数据库中搜索与DUST和CIRF定义相关的体外和体内文章,2023年11月，使用关键字组合：\“灰尘\”，\"石头\",“尿路结石”，“尿石症”，\"剩余片段\",\"除尘\",\"fragments\",“激光”和“临床上无关紧要的残留碎片”。
结果：DUST与尿路结石的细碎有关，在体外定义为颗粒自发漂浮，沉降持续时间≥2秒，适合通过输尿管软镜（FURS）的3.6Fr工作通道（WC）抽吸。一般来说,250µm的尺寸上限似乎与DUST的定义一致。Ho：有和没有“摩西技术”的YAG，TFL和最近的脉冲-Thulium：YAG（pTm：YAG）可以产生粉尘，但目前还没有围手术期技术可以测量粉尘大小。与Ho:YAG相比,TFL和pTm:YAG实现更好的除尘。CIRF涉及与即将发生的结石相关事件无关的残留碎片（RF）：腰部疼痛，急性肾绞痛,医疗或介入治疗。从基于冲击波碎石术（SWL）（≤4mm）的较早研究到基于FURS（≤2mm）和经皮肾镜取石术（PCNL）（≤4mm）的较新研究，CIRF尺寸定义有所下降。RF≤2mm与下结石复发相关，再生长和临床事件发生率。术后应使用非对比计算机断层扫描（NCCT）评估CIRF，对于评估DUST的存在和数量的最佳诊断方式尚无共识。
结论：DUST和CIRF是指独立的实体。DUST在体外定义为250µm的石头粒度标准，临床翻译为能够通过3.6Fr-WC完全吸入的颗粒而不会堵塞。CIRF与术后NCCT≤2RF相关。
方法：Embase，在MEDLINE(PubMed)和Cochrane数据库中搜索与DUST和CIRF定义相关的体外和体内文章,2023年11月，使用关键字组合：\“灰尘\”，\"石头\",“尿路结石”，“尿石症”，\"剩余片段\",\"除尘\",\"fragments\",“激光”和“临床上无关紧要的残留碎片”。
结果：DUST与尿路结石的细碎有关，在体外定义为颗粒自发漂浮，沉降持续时间≥2秒，适合通过输尿管软镜（FURS）的3.6Fr工作通道（WC）抽吸。一般来说,250µm的尺寸上限似乎与DUST的定义一致。Ho：有和没有“摩西技术”的YAG，TFL和最近的脉冲-Thulium：YAG（pTm：YAG）可以产生粉尘，但目前还没有围手术期技术可以测量粉尘大小。与Ho:YAG相比,TFL和pTm:YAG实现更好的除尘。CIRF涉及与即将发生的结石相关事件无关的残留碎片（RF）：腰部疼痛，急性肾绞痛,医疗或介入治疗。从基于冲击波碎石术（SWL）（≤4mm）的较早研究到基于FURS（≤2mm）和经皮肾镜取石术（PCNL）（≤4mm）的较新研究，CIRF尺寸定义有所下降。RF≤2mm与下结石复发相关，再生长和临床事件发生率。术后应使用非对比计算机断层扫描（NCCT）评估CIRF，对于评估DUST的存在和数量的最佳诊断方式尚无共识。
结论：DUST和CIRF是指独立的实体。DUST在体外定义为250µm的石头粒度标准，临床翻译为能够通过3.6Fr-WC完全吸入的颗粒而不会堵塞。CIRF与术后NCCT≤2RF相关。
