Dusting Versus Fragmentation With Holmium:YAG Laser During Transurethral Cystolithotripsy in Pediatric Bladder Stones: A Prospective Randomized Trial

What this Trial Is About

Researchers are evaluating two different Holmium:YAG laser techniques for treating children with a single bladder stone smaller than 3 cm. This trial compares the dusting method, which breaks the stone into fine particles, with the fragmentation method, which creates larger pieces that may be actively removed. The purpose is to find out which laser strategy results in shorter surgery time and better stone clearance in pediatric patients. Children will be randomly assigned to one of two groups for transurethral laser cystolithotripsy under general anesthesia. In the dusting group, low pulse energy and higher frequency settings (0.5-0.8 J and 10-15 Hz) will be used to reduce stones to tiny fragments with minimal extraction. The fragmentation group will receive higher pulse energy and lower frequency settings (1.0 J and 6-10 Hz) aiming to produce visible fragments sized 2-5 mm that can be removed. Procedures use a pediatric semi-rigid ureteroscope in the lithotomy position with a 550-micron laser fiber. Participants will be monitored during and after the procedure for total operation time, laser time, need for fragment extraction, and stone-free status via endoscopy and ultrasound. Follow-up visits at 1 week, 1 month, and 3 months will assess urinary symptoms, infections, catheter need, and hospital stay length. Safety will be evaluated by tracking complications such as mucosal injury, bleeding, hematuria, and dysuria. The study will last until May 2027.

Dusting vs Fragmentation Laser Cystolithotripsy for Pediatric Bladder Stones