What is the exact definition of stone dust? An in vitro evaluation

Abstract

Purpose

To propose a size-related definition of stone dust produced by lithotripsy of urinary stones.

Methods

Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40 cm H2O irrigation pressure; (2) mean sedimentation time of > 2 s through 10 cm saline solution; (3) fully suitable for aspiration through a 3.6 F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2 mm, ≤ 1 mm, ≤ 500 µm, ≤ 250 µm, ≤ 125 µm and ≤ 63 µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine.

Results

All particles ≤ 250 µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125 µm.

Conclusion

A size limit of ≤ 250 µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.

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Funding

Dr. Etienne Xavier Keller is a consultant for Olympus, Recordati and Debiopharm, and has been supported by a Travel Grant from the University Hospital Zurich and from the Kurt and Senta Herrmann Foundation 2017–2018. Dr. Vincent De Coninck is a consultant for Boston Scientific, BD Bard and Coloplast, and has been supported by the EUSP scholarship from the European Association of Urology and by a Grant from the Belgische Vereniging voor Urologie (BVU) from 2017 to 2018. Dr. Steeve Doizi is a consultant for Coloplast and Boston Scientific. Prof. Michel Daudon is a consultant for Advicenne. Prof. Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific and IPG Medical.

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EXK: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. VDC: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. SD: data analysis and manuscript writing/editing. MD: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. OT: protocol/project development, data analysis, and manuscript writing/editing.

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Correspondence to Olivier Traxer.

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Keller, E.X., De Coninck, V., Doizi, S. et al. What is the exact definition of stone dust? An in vitro evaluation. World J Urol 39, 187–194 (2021). https://doi.org/10.1007/s00345-020-03178-z

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Keywords

  • Urolithiasis
  • Stone dust
  • Laser lithotripsy
  • Stone composition
  • Ureteroscopy
  • Percutaneous nephrolithotomy