High Powered Stone Dusting vs. Fragmentation and Basketing at Time of Ureteroscopy

On the day of surgery, the treatment assigned to the patient will be determined by chance, like flipping a coin. Neither the patient nor the study doctor will choose the treatment type. Each patient will have an equal chance of being given either surgical treatment. One group will have stones treated with high-powered laser dusting and the dust produced will pass spontaneously through the urine. The other group will have stones treated with low power laser fragmentation and stones will be removed using a basket. The surgical procedure will not differ from the treatment a patient would receive if he/she were not in this study.

After surgery, participants will complete a pain assessment questionnaire in the outpatient recovery area before being discharged to go home. Participants will also receive a daily email or text message to assess pain and daily activities. Participants will answer these questions daily until pain has resolved and daily activities have returned to baseline levels.

Six weeks after surgery, participants will undergo an ultrasound to assess for swelling of a kidney due to a build-up of urine (called hydronephrosis), which is standard of practice after ureteroscopy. Participants will also return to the urology clinic 12 weeks after surgery for a standard of care follow up visit. At this visit, participants will undergo standard of care procedures known as renal bladder ultrasound and kidney ureter bladder abdominal x-ray to evaluate for stones. Participants will also complete another pain assessment questionnaire at this appointment.

Researchers will review the medical record to evaluate the effectiveness of the surgery at removing kidney stones and preventing kidney stone recurrence as well as to track quality of life outcomes.

Inclusion criteria

• >18 years of age
• undergoing ureteroscopic stone extraction
• Stone size 6mm stones or greater and the location to mid ureter or higher
• Willing to sign informed consent form
• Able to read, understand, and complete patient questionnaires, and pain questionnaires

Exclusion criteria

• < 18 years of age
• Inability to provide informed consent
• Concomitant surgery (i.e. Percutaneous nephrolithotomy, Holmium laser enucleation of the prostate
• Solitary kidney
• Nephrocalcinosis
• Members of vulnerable patient populations
• Patients without access to a phone that can receive txt messages