Transurethral Versus Percutaneous Cystolithotripsy for Bladder Stones in Adults

N/ANot Yet RecruitingNCT07810582

Assiut University50 enrolled

Overview

This study evaluates and compares two minimally invasive surgical approaches for treating bladder stones in adult patients: transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL). Urinary bladder stones are commonly managed using endoscopic techniques to avoid the morbidity of open surgery. TUCL accesses the bladder through the natural urinary channel (urethra), whereas PCCL accesses the bladder directly through a small puncture in the lower abdomen above the pubic bone. While both approaches are effective, comparative data in adult populations remain limited. Eligible participants are randomly assigned to receive either TUCL or PCCL. The primary goal is to compare stone clearance rates and operative times between the two procedures. Secondary objectives include comparing surgical complication rates, duration of postoperative urinary catheterization, and length of hospital stay.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Urinary Bladder Calculi Bladder Calculi Urolithiasis

Interventions

Transurethral CystolithotripsyPROCEDURE

Under spinal or general anesthesia, a rigid cystoscope is introduced transurethrally under direct vision. Bladder calculi are visualized and fragmented using a Mauermayer stone punch and/or pneumatic lithotripter via a semirigid ureteroscope according to stone size and consistency. Stone fragments are evacuated using an Ellik evacuator and/or grasping forceps. Complete clearance and mucosal integrity are confirmed by cystoscopy, followed by insertion of a two-way urethral Foley catheter.

Percutaneous CystolithotripsyPROCEDURE

Under spinal or general anesthesia, the bladder is distended retrogradely with 300-400 cc sterile irrigation fluid via cystoscopy. Under combined ultrasound and cystoscopic guidance, a midline suprapubic percutaneous puncture is executed using an 18G needle, followed by guidewire placement, tract dilation, and insertion of a 30 F Amplatz working sheath. A 26 F rigid nephroscope is introduced, and calculi are fragmented using a pneumatic lithotripter and removed with grasping forceps. A urethral Foley catheter is placed postoperatively, with or without a suprapubic tube based on intraoperative findings.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients aged 18 years or older * Diagnosed with single or multiple urinary bladder stones * Stone diameter between 1 and 4 cm at its largest diameter or cumulative stone diameter * Candidates for both transurethral and percutaneous endoscopic treatment modalities Exclusion Criteria: * Active urinary tract infection (UTI) * Uncorrected coagulopathy or bleeding disorders * Known urethral stricture or significant urethral pathology precluding safe transurethral instrumentation * History of bladder augmentation, major lower abdominal surgery, or pelvic radiotherapy * Concomitant bladder tumor or suspected bladder neoplasm * Stone located within a bladder diverticulum or within a contracted bladder * Requiring concomitant urological procedures during the same operative session (e.g., transurethral resection of the prostate \[TURP\] or lower ureteric stone extraction) * Urethral stones pushed back into the bladder * Refusal to participate in the study

Outcomes

Primary Outcomes

Stone-Free Rate

Stone-free status is defined as complete stone clearance or presence of clinically insignificant residual fragments (CIRF) \<= 2 mm confirmed by direct endoscopic inspection.

Time frame: 1 day