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.
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。