Transurethral Cystolithotripsy Research Articles

Endemic Bladder Stone Disease in Children, Pattern And Current Management: Experience From A Centre In Peri-Urban Setting In Pakistan.

To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting. This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables. This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC. Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Current aspects of surgical methods for removal of bladder stones in patients with bladder outlet obstruction

The prevalence of bladder stones is quite high, which represents a significant medical and social problem. Despite significant progress in the field of medicine, there are currently no generally accepted standards for the treatment of patients with cystolithiasis. This review presents an analysis of literature sources using the PubMed, Google Scholar, Scopus, eLibrary, Cyberleninka databases, dedicated to modern aspects of the treatment of patients with bladder stones and bladder outlet obstruction. The features, advantages and disadvantages of various surgical methods for treating such patients are described in detail. It has been shown that despite the fact that transurethral cystolithotripsy with litholapaxy is the most common surgical option, modern medicine offers alternative methods of surgical treatment. It is emphasized that to achieve the greatest effectiveness of treatment, the correct choice of surgical method is necessary, based on the individual characteristics of the patient. It was noted that there is a need to optimize the treatment algorithm for patients with bladder stones and bladder outlet obstruction.

Percutaneous basket-guided transurethral cystolithotripsy – An innovation for the management of bladder stones

Percutaneous basket-guided transurethral cystolithotripsy – An innovation for the management of bladder stones

Comparison of three techniques in bladder stone surgery: Which technique is more effective and safe?

In our study, we aimed to compare the success and complication rates of percutaneous cystolithotripsy (PCCL), transurethral cystolithotripsy (TUCL), and Ho: YAG laser lithotripsy in the surgery of bladder stones that occurred due to various reasons. Patients diagnosed with single or multiple bladder stones with long axis larger than 2 cm, resulting for various reasons, were included in ou study. Sizes of the stones, cystolithotripsy and discharge times, catheter removal times, complications observed, and the visual pain scale (VPS) were retrospectively evaluated separately from the surgical techniques implemented for accompanying patients and their data. TUCL (group 1) was implemented in 40, PCCL (group 2) was implemented in 44, and transurethral Ho: YAG laser lithotripsy (group 3) was implemented in 30 of the 121 patients included in the study. The bladder stone long axe group 1 average was 3,7 cm (2,2-5,3), group 2 average was 3,74 cm (2,1-5,1), and group 3 average was 3,7 cm (2,3-4,7). Urethral stricture evolved in two patients who underwent TUCL. A statistically significant difference was observed on behalf of PCCL in terms of operation time. There was significance in the Ho: YAG laser cystolithotripsy group in comparison with VPS scores. No significant differences were found in terms of age, stone size, urethral catheter removal times, and discharge times. The average follow-up time was 6 months. Although all three methods were quite successful in bladder stone surgery, average cystolithotripsy times were significantly low in the PCCL technique. Thinking that the most common cause of bladder stone is BPH, it is stated that the suprapubic inserted tube ease the bladder drainage during transurethral resection of the prostate (TUR-P). In this way, the duration of the most common accompanying surgeries is shortened and performed more safely.

Thulium fiber laser cystolithotripsy under local anesthesia: A day care procedure.

Bladder stones account for 5% of all urolithiasis. Patients present with LUTS or acute urinary retention. Thus, warranting an early intervention. Minimally invasive approach with laser lithotripsy is the present gold standard to treat bladder stones. To evaluate the outcomes of TFL (60 W) for bladder stones performed under local anesthesia as a day-care procedure. This was a retrospective single-center study conducted after obtaining IRB approval. Study period was between June 2021 and June 2022 were included. All patients were operated under local anesthesia as a day care procedure. The procedure was carried out using an 18 Fr laser sheath and calculus dusted using TFL energy (15-30 W). Parameters including operative time in minutes, complications were recorded. Patients were encouraged oral and normal voiding in the immediate post-op period. A total of 47 patients with bladder stones presented during this period. Of these, 30 underwent laser lithotripsy (TFL) for bladder calculi. The clinical presentation of patients was LUTS in 28 (93%) and 5 (16%) patients had AUR. The average size of the stone in this series was 15 ± 2.8 mm. The mean duration of laser lithotripsy was 15 ± 5.4 min. Energy to dust the stone was variable with mean LASER energy of 18.23 ± 10 W. All patients tolerated the procedure well and none required conversion to conventional anesthesia. One patient failed to void in the post-op period. 100% clearance rate was documented in all patients. Thulium fiber laser for transurethral cystolithotripsy of bladder stones under local anesthesia is a feasible technique with minimal morbidity and good outcome.

Endourological versus open cystolithotomy for bladder stone management among children: A systematic review and meta-analysis.

Background: The treatment of choice for bladder stones in children remains debatable. This study aimed to compare the outcomes of endourological and open cystolithotomy for the management of bladder stones in children. Methods: The Medline, Embase, Cochrane controlled trial databases and clinicaltrials.gov were searched for relevant English-language publications from 1 to 30 August 2022. Stone-free rate (SFR), complication rate, length of stay, and procedure duration were compared. Children (male and female) <18 years of age of any ethnicity with bladder stones (single/multiple) were included. Patients with a history of bladder augmentation or diversion were excluded. The quality of studies included was assessed using Cochrane's Risk of Bias Assessment. The meta-analysis was performed using RevMan. Results: Five articles (436 participants) that compared endourological versus open cystolithotomy were included in qualitative and quantitative analyses. Four were non-randomised, retrospective, and single centre studies. While the other one was a randomised controlled trial. Measure outcome characteristics included SFR, complications, procedure duration, and length of hospital stay. There was no significant difference in the SFR between transurethral cystolithotripsy (TUCL) and percutaneous cystolithotomy (PCCL) ( p=0.22). There were also no significant differences in complications (TUCL versus PCCL, p=0.18; TUCL versus open cystolithotomy [CL] and PCCL versus CL, p=0.08). PCCL featured a longer procedure duration than TUCL ( p<0.00001), while CL was shorter than TUCL and PCCL (both p<0.00001). Finally, in terms of length of stay, TUCL was superior to PCCL and CL, while PCCL was better than CL (all p<0.00001). Conclusions: Endourological and open surgical management of bladder stones in children showed comparable SFR and fewer complications. Open surgery offers a shorter procedure duration than endourological management, but PCCL features a shorter procedure duration than TUCL. In terms of length of stay, TUCL and PCCL were superior to CL, while TUCL was better than PCCL.

Comparison of Percutaneous Cystolithotripsy and Transurethral Cystolithotripsy for Treatment of Medium Size Bladder Stone: A Retrospective Study

Introduction: Vesical calculus accounts for nearly 5% of urinary system calculi and is commonly seen in patients with Bladder Outlet Obstruction (BOO), chronic infection, and neurogenic bladder. Open cystolithotomy is an invasive surgery with a long postoperative period and with a high wound infection rate, so only best recommended for large stones. With recent advancements in endourological instruments, cystolithotripsy either by Percutaneous Cystolithotripsy (PCCL) or Transurethral Cystolithotripsy (TUCL) approach has become a safer treatment for medium size stone (2-4 cm). Aim: To compare the outcome of PCCL and TUCL for medium size bladder stones in adult patients. Materials and Methods: This retrospective study was conducted between January 2019 to December 2021 in the Department of Urology, Superspeciality Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. Group I was PCCL (n=32) and group II was TUCL (n=30). PCCL group was compared with TUCL group II for age, stone size, number of stones, operative time, mean urethral entries, postoperative hospital stays, peri and postoperative complications. Statistical analysis was performed using Chi-square and t-test. Differences were accepted to be statistically significant at p-value≤0.05. Results: A total of 168 were treated for bladder stones in the Institute and 62 patients were included in the study. No residual stone was observed in any of the two groups. Complete stone clearance was achieved in both groups of patients. Mean operative time and the number of urethral entries were 46.75±2.45 min and 1.06±0.25 min in in the PCCL group, and 59.67±3.84 min and 2.87±0.82 min in in the TUCL group. (p-value-&lt;0.001). Conclusion: PCCL appears to be a better technique and preferable over TUCL in bladder stones of size between 2-4 cm.

The Effectiveness and Safety of Percutaneous Cystolithotripsy for Vesicle Calculus in Children: A Single-Center Study

Background: Primary bladder stones are common among children from developing countries but may be difficult to cure. Transurethral cystolithotripsy, open cystolithotomy, and shock wave lithotripsy are the treatment modalities for vesical calculi in children. Transurethral lithotripsy is less efficient in children because of the small caliber of the urethra. PCCL is a less intrusive and efficient procedure for removing bladder stones in pediatric patients. Objectives: The objective of the study was to determine the safety and efficacy of PCCL in children with bladder stones in third-world nations. Materials and Methods: There was a search for( PCCL) in pediatric individuals diagnosed with vesical calculus. 90% male and 10% female total of 120 patients enrolled in the single-center trial at the Department of Pediatric Urology at the Institute of Kidney Diseases between January 2021 to January 2022. The surgery was performed under a general anesthetic. After a thorough inspection, a suprapubic puncture of the lower urinary tract (by cystoscopy) was done. The tract was only dilated up to 14 Fr. The stone was fragmented using pneumatic lithotripsy after passing the nephroscope. After 36 hours per urethral catheter was removed. Results: In this study, the mean age of the patients was 4.2.14 years. The majority of patients were kids. The average gem was 9.3 millimeters in diameter. Successful stone fragmentation and retrieval took place in an average of 40 min. The only major problems seen during or after surgery were hematuria, infection, and moderate mucosal injury; all three were managed conservatively. In 108 out of 120 cases (90%), ammonium acid urate was found to be the primary constituent of the stones and the core. Conclusion: The success rate of percutaneous cystolithotripsy in the treatment of bladder stones in children is higher, and it is ready for immediate use. The operation is quick and causes minimal discomfort. Keywords: Effectiveness, Percutaneous , Cystolithotripsy, Vesical Calculus, Children

Safety and Efficacy of Transurethral Cystolithotripsy in Pediatric Population: A Single Center Study

Introduction: Bladder stone treatment in children is evolving rapidly. Vesicolithotomy has now been rarely used except in very large stone and even larger stones are treated with percutaneous cystolithotripsy, which is still more invasive compared with transurethral cystolithotripsy. We have evaluated a series of 150 case of bladder stone in children with this minimal approach through natural orifice i.e. urethra to assess its feasibility, efficacy and complications. Objective: To assess the safety and efficacy of transurethral cystolithotripsy for bladder stone in pediatric population. Material and Methods: This study was conducted in the Institute of Kidney Diseases and Transplant HMC Peshawar Pakistan from Jan 2020 to Apr 2022. A series of 150 patients were assessed with a mean age of 7.5+-2.9 years and mean stone size of 11.2+-3.6mm. Mean operative time was 28.1+- 5.8 minutes, mean hospital stay was 0.2+-1. A total of 89.33% of were treated as a day case. Two patients (1.3%) needed re-cystolithotripsy while in none of the cases were converted to open or PCCL. Postoperatively 16 (10.67%) patients developed Clavien grade 1 complications and 2(1.33%) patients developed Clavien grade III complication. Conclusion: Trans-urethral cystolithotripsy is feasible and effective in pediatric population with acceptable clearance rate and low grade complication for stones up to 20 mm. However comparison with open method is needed. Keywords: Bladder stone, Trans-urethral, Cystolithotripsy.

Clinical study and management of bladder calculus in patients presenting to VMKVMC hospital

Aim: To study and analyse the clinical findings, pattern, various management and their outcome of bladder calculus in patients visiting VMKVMC hospital. Methodology: In this retrospective study about Fifty patients with bladder calculus were selected and datas like urine examination, ultrasonogram (USG), X ray KUB were noted. The Management performed in those patients were open suprapubic cystolithotomy or transurethral cystolithotripsy or percutaneous cystolithotripsy. Patients’ symptoms, socio- economic status, composition of calculus and post- operative complications were recorded. Results: Out of 50 patients, 30 were male (64%) and 20 were female (36%). Management done was open suprapubic cystolithotomy in 8, transurethral cystolithotripsy in 28 and percutaneous cystolithotripsy in 14 patients. Composition of bladder stones was Caph. CaOx, uric acid in 24, CaOx, uric acid in 3, MAP CaOx uric acid in 16, MAP CaOx in 3, uric acid in 2 and CaOxAmm. Urate in 2 patients. Conclusion: The study revealed that maximum males were affected and transurethral cystolithotripsy was the most common management performed.

A randomised trial comparing transurethral to percutaneous cystolithotripsy in boys.

To compare the efficacy and morbidity of transurethral cystolithotripsy (TUCL) and percutaneous CL (PCCL) in the management of bladder stones in male children. A total of 100 boys, aged <14 years with a single bladder or urethral stone of <30 mm, were randomised into two equal groups. Initial diagnostic urethro-cystoscopy and push back of urethral stones were done for patients in both groups. Patients in Group A had TUCL, while those in Group B had PCCL through a 20-F sheath using a 12-F nephroscope. The two groups were compared regarding preoperative criteria, intraoperative details, and postoperative outcomes. The patients in this study had a median (range) age of 36 (4-144) months and stone size of 10 (5-26) mm. There was no statistically significant difference between the two groups for preoperative criteria. The assigned procedure was successful in 48 (96%) patients in Group A and 49 (98%) in Group B (P = 1). Complications were encountered in 11 (22%) patients in Group A and five (10%) in Group B (P = 0.171). The median (range) operative time was 21.5 (4-90) min in Group A and 13 (5-70) min in Group B (P < 0.001). In all, 47 (94%) stones needed disintegration in Group A vs 22 (44%) in Group B (P < 0.001). Both techniques have comparable success and complications rates. However, PCCL has a shorter operative time and less need for stone disintegration.

Comparison of two different minimally invasive techniques used in bladder stone surgery for preschool-aged children.

This study was designed to compare the outcomes of mini-percutaneous cystolithotomy (mPCL) and transurethral cystolithotripsy (TUCL) in treating bladder stones in preschool-aged children (≤6 years old). Twenty-four patients treated with mPCL and 28 patients treated with TUCL for bladder stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed. The mean age and gender distribution were similar between the groups. The mean stone size was 16.5 ± 0.5 mm for the mPCL group and 14.9 ± 5.7 mm for the TUCL group (p = 0.318). The mean operative time was 41.1 ± 9.9 min for the mPCL group and 39.0 ± 12.3 min for the TUCL group (p = 0.182). Catheterization times and hospitalization times were statistically significantly longer in the mPCL group (p = 0.000). The rate of urinary retention after urethral catheter removal was significantly higher in the TUCL group (p < 0.05). Reintervention was performed for one patient in Group 1 due to urinary leakage and for five patients in Group 2 due to urinary retention. The stone-free rate (SFR) after a single procedure was 100% in the mPCL group and 89.3% in the TUCL group (p = 0.099). After auxiliary procedures performed for three patients, the overall SFR also reached 100% for the TUCL group. Both mPCL and TUCL are effective methods in the treatment of bladder stones of <30 mm in the preschool age group. Although TUCL has some advantages over mPCL, such as shorter hospital stays and catheterization times, there is a risk of urinary retention with increased stone sizes. It may be more advantageous to apply mPCL for the reduction of complications and reintervention rates, especially in small children with bladder stones of >20 mm.

Transurethral Holmium Laser Cystolithotripsy Under Local Anaesthesia in Adult Patients: A Prospective Observational Study at a Tertiary Care Centre in North-east India

Introduction: Urinary bladder stones comprise 5% of all urinary stones. Various modalities for the treatment of symptomatic bladder stones are available. They are open cystolithotomy, extra corporeal shock wave lithotripsy, cystolitholapaxy, suprapubic or transurethral cystolithotripsy using various energy sources. Presently transurethral Holmium laser cystolithotripsy is considered as the treatment of choice for symptomatic bladder stones. Aim: To report the experience of holmium laser cystolithotripsy for the treatment of symptomatic urinary bladder stones under local anaesthesia in adult patients. Materials and Methods: This prospective observational study was conducted on 86 patients at Department of Urology, NorthEastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India, between June 2016 and August 2019. It included consecutive adult patients with symptomatic bladder stones of size upto 4 cm who underwent transurethral holmium laser cystolithotripsy under local anaesthesia during the study period. Laser energy was delivered through a 9.5F semi rigid ureteroscope using 365 µm or 550 µm end-firing fibre. Pain during the procedure was assessed using Visual Analogue Scale (VAS). Descriptive statistics was used for analysis of the results. Results: During the study period, 86 patients (84 men, 2 women) underwent transurethral Holmium laser cystolithotripsy under local anaesthesia. Complete fragmentation of the stones was achieved in all patients. The mean stone size was 15.04 mm and the mean operating time was 23.81 minutes. The procedure was well tolerated by the patients and the mean pain score was 3.26. It was associated with minor complications only. There was no major complication or mortality during the study. Conclusion: Transurethral holmium laser cystolithotripsy under local anaesthesia is a safe procedure. It is well tolerated by adult patients and it can be used for the treatment of bladder stones of size upto 4 cm.

Оценка эффективности гольмиевой лазерной литотрипсии при лечении собак с уролитиазом

Currently, the main method of treating surgical pathologies of the bladder in animals is the classical method of cystotomy performed using laparotomy, which is characterized by significant trauma and an increased risk of postoperative complications. To reduce the incidence of complications, it is recommended to use minimally invasive surgery methods, such as transurethral cystolithotripsy and laparotomically assisted cystolithotripsy. The authors conducted clinical studies aimed at evaluating the effectiveness of new minimally invasive surgical methods for the treatment of urolithiasis in dogs. One of the methods is lithotripsy, which is carried out using a holmium laser, under the action of which, fragmentation of uroliths occurs and their excretion from the body without the use of any accesses to the bladder. In the article, the authors studied the characteristics and possibilities of using lithotripsy in practice in dogs. Based on the results presented by the authors, one of the significant advantages of transurethral cystolithotripsycan be identified. It is the lack of operative access, which avoids the use of suture material, which can cause complications in the form of fistulas, peritonitis due to the failure of the suture, adhesive disease of the abdominal cavity, as well as incorrect suturing of the bladder wall, salt deposits may form on the suture material, followed by the formation of uroliths.

Percutaneous cystolithotripsy for patients with benign prostatic hyperplasia

Introduction. According to the literature, 5.0% of patients with urolithiasis are characterized by the presence of stones in the bladder. The issue of bladder stones for patients with benign prostatic hyperplasia remains relevant and requires further improvement of approaches to surgical treatment.Purpose of the study. To evaluate the safety and efficacy of energy-diverse percutaneous cystolithotripsy (and placement of a cystostomy catheter) in comparison with transurethral cystolithotripsy.Materials and methods. A retrospective analysis of 56 cases in patients (aged 54-82 years) with bladder stones was carried out. All patients were treated in the Urology Clinic of the Mechnikov North-Western State Medical University from 2019 to 2021. Two groups were formed: group I — 26 (46.4%) patients who underwent percutaneous cystolithotripsy, group II — 30 (53.6%) patients underwent transurethral cystolithotripsy. The duration of surgery, intraoperative and postoperative complications were assessed.Results. On average, the duration of surgery for the percutaneous approach was shorter than for transurethral access (35 vs 44 min). The stone-free rate in the case of the percutaneous approach was 100.0%, while in transurethral cystolithotripsy the stone-free rate was 90.0%. In the early postoperative period, in groups I and II, gross hematuria was observed for 2 (7.6%) and 4 (13.3%) patients, respectively. In the late postoperative period, 2 patients from group II had a urethral stricture.Conclusions. Percutaneous cystolithotripsy is a minimally invasive method of stone fragmentation, characterized by a minimal risk of intra- and postoperative complications.

Application of improved percutaneous cystolithotripsy in patients with benign prostatic hyperplasia

Introduction. The article presents an improved method of percutaneous cystolithotripsy. The results of its application are described and a comparison is made with the traditional method of transurethral cystolithotripsy with lithoextraction. The study objective is development of a comprehensive method of treating patients with bladder stones arising against the background of bladder outlet obstruction caused by benign prostatic hyperplasia (BPH), assessment of its effectiveness and safety.Materials and methods. The treatment was carried out in 56 patients with bladder stones arising on the background of BPH at the age from 42 to 89 years. According to the proposed method, 20 patients with BPH (main group) were operated on. Transurethral cystolithotripsy (control group) was performed in 36 patients. The results of the performed operations were compared with each other.Results. According to the comparison results, it is noted that the proposed method of percutaneous cystolithotripsy is performed faster and more efficiently, due to the fixation of the calculus in the basket. Due to the presence of a laparoscopic bag that completely isolates the stone from the bladder wall, there were no intraoperative complications. Drug therapy made it possible to quickly level the symptoms of cystitis. The patients were discharged 4-6 days after surgery with a cystostomy, which was removed after treatment for BPH.Conclusion. The proposed complex treatment of patients with bladder stones on the background of BPH is a safe method and has clear advantages over traditional transurethral, contact cystolithotripsy with lithoextraction.

Assess the safety and effectiveness of a novel approach during transurethral pneumatic cystolithotripsy in large urinary bladder stone: quasi-clinical trial

To assess the safety and efficacy of using continuous irrigation-modified hysteroscopy during transurethral pneumatic cystolithotripsy for large bladder calculi. A prospective study was carried out from May 2016 until March 2020. All patients with solitary or multiple bladder stones > 2.5cm were subjected to Transurethral pneumatic cystolithotripsy using a modified continuous irrigation hysteroscopy, the stone fragments were removed by Ellik Evacuator, the safety and effectiveness of the procedures were evaluated, stone-free rate (SFR), stone recurrence and stricture urethra disease during follow-up. 55 patients with a mean age of 57.36 (22-82) years were included, the male: female ratio was 4:1, single stone in 74.5% and the mean stone size was 52mm. Lithotripsy time and an operative time were (20.39 ± 3.06 and 32.00 ± 3.57) minutes, respectively. Mean hospital stay was 10 ± 3.6h. This endoscopic technique succeeded with a 100% SFR. During the 22months of follow-up, no urethral stricture or stone recurrence was documented. The mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, respectively, during and after the operation. The use of the modified hysteroscopy sheath during transurethral pneumatic cystolithotripsy is safe and effective for the management of large urinary bladder stones, an alternative to holmium laser in developing countries when laser equipment is unavailable. Comparable to other transurethral maneuvers, with a decrease in the risk of urethral stricture disease due to the small caliber of the device, as there is no urethral dilatation is required.

Comparison of nephroscopy and cystoscopy used in the treatment of bladder stones: a systematic review and meta-analysis of randomized controlled trials

BackgroundA systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscopy and cystoscopy in transurethral cystolithotripsy (TUCL) for bladder stones (BS).MethodsThe PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases were searched up to January 2021 for studies assessing the effect of different types of endoscopes among patients who underwent TUCL. The search strategy and study selection process were in accordance with the PRISMA statement.Results Five randomized controlled trials were included in the meta-analysis. The results showed no difference in stone-free rate (RR = 1.00, CI = 0.98–1.02, p = 1.00) between the two groups and nonsignificant heterogeneity (I2 = 0%, p = 1.00), and all patients were rendered stone free. Use of the nephroscope significantly shortened the operative time compared with the cystoscope group (RR= − 26.26, CI = − 35.84 to − 16.68, p < 0.00001), and there was significant heterogeneity (I2= 87%, p < 0.00001). There was no significant difference in mean urethral entries (RR = 0.66, CI = − 0.71 to − 2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = − 0.07 to 0.23, p = 0.31) or total complication rate (RR=1.37, 95% CI = 0.47–4.00, p = 0.56) between the two groups.ConclusionsIn conclusion, this systematic review demonstrates that both nephroscopy and cystoscopy have high stone clearance efficiency, low rates of complications and short hospitalizations. The mean urethral entries depend on the treatment method for large stone fragments. However, the use of nephroscopy can significantly reduce the operative time.

Comparative Study between Percutaneous Approach and Transurethral Approach for Treatment of Urinary Bladder Stones

Abstract Purpose The aim of this study is to compare outcome of percutaneous cystolithotripsy approach (pccl) vs transurethral cystolithotripsy approach (tucl) in treatment of large urinary bladder stones regarding efficacy, safety and peri-operative complications. Methods This study included 60 patients who had urinary bladder stone, treated at Ain Shams University hospitals in Egypt from March 2019 to March 2020 and randomly assigned into two groups: group A: percutaneous cystolithotripsy (PCCL) and group B: transurethral using nephroscope combined with meurmayer stone punch (tucl). Baseline and perioperative data were recorded and compared between two groups. Results Baseline parameters and the peri-operative complications (fever, transient haematuria, urinary bladder perforation, suprapubic wound infection and persistent leakage from suprapubic site) were compared between the two groups. Complete stone clearance was achieved in all the patients. The mean operative time in pccl group and tucl group was (30±7 min and 32±7 min) respectively. Urinary catheter duration in Pccl group was significantly more than Tucl group. Till the last follow-up, 6.6% patients (n = 2) developed urethral stricture in Tucl group. Conclusions PCCL is a safe procedure with acceptable morbidity and can be used as an alternative to tucl in treating (2-4 cm) urinary bladder stones.

Which Endoscopic Methods in Prepubertal Patients with 10-20 mm Bladder Stones: Transurethral Cystolithotripsy or Percutaneous Cystolithotripsy?

Background: The aim of this study was to evaluate the efficacy and safety of transurethral cystolithotripsy (TUC) and percutaneous cystolithotripsy (PCC) in prepubertal patients with 10-20 mm bladder stones. Materials and Methods: The files of patients aged 12 years and under who were admitted to our clinic for bladder stones from January 2007 to January 2021 were reviewed retrospectively. Inclusion criteria were patients who were 12 years of age and under with 10-20 mm bladder stones, and who underwent endoscopic surgery (TUC or PCC). None of the patients had prior bladder or stone surgery. The patients were divided into two groups (Group 1: PCC group, and Group 2: TUC group) and collected data (preoperative, intraoperative, and postoperative characteristics) were compared between the groups. Results: This study was enrolled 51 patients (21 patients in Group 1 and 30 patients in Group 2). The mean ages of the groups were similar (Group 1: 4.7 ± 3.6; Group 2: 4.6 ± 3.2; p = 0.936). The mean stone size was 15.8 ± 3.5 in Group 1, and 12.1 ± 2.4 mm in Group 2. It was higher in the PCC group than TUC group (p < 0.001). The operative time was lower in Group 1 than Group 2 (36.4 ± 12.9 vs 42.7 ± 16.3 minutes, respectively), but there was no statistically significant difference between the groups (p = 0.117). We achieved stone-free rate (SFR) for all the patients in both groups. Complications were observed in 4 (7.7%) cases. One female patient was in Group 1 and three male patients were in Group 2. There was no difference for complication rates between the groups (p = 0.634). Conclusions: Endoscopic surgeries have almost become a routine method in the treatment of bladder stones. Despite larger stone size, PCC provides similar SFR compared with TUC along with a tendency of shorter operative time. However, the use of the TUC method in male toddlers could increase the risk of postoperative urinary retention. Hence, stone size and patient age should be considered in the selection of a surgical approach.