Moretto S. et al., 2025: Stone dust in endourology: a systematic review of its definition, management, and clinical impact.

Thursday, 06 November 2025

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Stefano Moretto 1 2 3, Alberto Quarà 1 2 4, Federico Zorzi 1 2 5, Alejandra Bravo-Balado 1 2, Aideen Madden 1 2, Johan Cabrera 1 2, Mariela Corrales 1 2, Luigi Candela 1 2, Steeve Doizi 1 2, Frederic Panthier 1 2, Olivier Traxer 1 2
1Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France.
2GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France.
3Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy.
4Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
5Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.

Abstract

Objective: To evaluate and synthesise the existing literature on stone dust (DUST) in endourology, focusing on its definition, creation methods, and removal techniques.

Methods: 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.

Results: 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.

Conclusions: 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.

BJU Int. 2025 Aug;136(2):185-197. doi: 10.1111/bju.16765. Epub 2025 May 9. PMID: 40345994; PMCID: PMC12256740

Comments 1

Hans-Göran Tiselius on Thursday, 06 November 2025 11:00

The authors have carried out a review to get information on the value of stone-DUSTING in endourological surgery. The methods are described only for laser fragmentation (Ho-YAG, TFL and p-TM:YAG). The purpose of dusting is to reduce particle size and thus counteract recurrent stone formation and facilitate fragment elimination. Although the results are important for understanding the course of small residuals (250 µm - less 2 mm) in terms of new stone growth and elimination, the report does not give any definite clues if dusting with some yet unknown technique also would be of value for SWL. It is interesting to speculate, however, what such a technical improvement could add to the non-invasive stone disintegration.
The literature review based on 43 reports has its focus on the definition of DUST. It is, however, not clear whether dust is superior to small residual fragments, but the authors’ bottom-line is that “the number of residual fragments requiring extraction increases with stone size”.
Would it be an advantage by developing a non-invasive dusting method for SWL? Unfortunately, that question cannot be answered from the data in this review because the authors did not specify the methods for dust- elimination. A basic question that needs an answer is if it is an advantage for stone elimination if the remaining fragments are up to 4 mm or dust (250 µm - less 2 mm)?

Hans-Göran Tiselius

The authors have carried out a review to get information on the value of stone-DUSTING in endourological surgery. The methods are described only for laser fragmentation (Ho-YAG, TFL and p-TM:YAG). The purpose of dusting is to reduce particle size and thus counteract recurrent stone formation and facilitate fragment elimination. Although the results are important for understanding the course of small residuals (250 µm - less 2 mm) in terms of new stone growth and elimination, the report does not give any definite clues if dusting with some yet unknown technique also would be of value for SWL. It is interesting to speculate, however, what such a technical improvement could add to the non-invasive stone disintegration.
The literature review based on 43 reports has its focus on the definition of DUST.  It is, however, not clear whether dust is superior to small residual fragments, but the authors’ bottom-line is that “the number of residual fragments requiring extraction increases with stone size”.
Would it be an advantage by developing a non-invasive dusting method for SWL? Unfortunately, that question cannot be answered from the data in this review because the authors did not specify the methods for dust- elimination. A basic question that needs an answer is if it is an advantage for stone elimination if the remaining fragments are up to 4 mm or dust (250 µm - less 2 mm)?

Hans-Göran Tiselius

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