Percutaneous or Transurethral Cystolithotomy for Bladder Lithiasis: Which is Safer?

Keywords: Lithotripsy/methods, Treatment Outcome, Urinary Bladder Calculi/surgery, Urinary Bladder Calculi/therapy


Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment.

Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered.

Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435).

Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.


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1. Schwartz DO, Stoller MD. The Vesical Calculus. Urol Clin North Am. 2000; 27: 333-46.

2. Tiselius HG. Epidemiology and medical management of stone disease. BJU Int. 2003; 91:758-67. doi:10.1046/j.1464-410X.2003.04208.x.

3. Tzortzis V, Aravantinos E, Karatzas A, Mitsogiannis IC, Moutzouris G, Melekos MD. Percutaneous suprapubic cystolithotripsy under local anesthesia. Urology. 2009; 68:38-41. doi: 10.1016/j.urology.2006.01.073.

4. Aron M, Agarwal MS, Goel A. Comparison of percutaneous with transurethral cystolithotripsy in patients with large prostates and large vesical calculi undergoing simultaneous transurethral prostatectomy. BJU Int. 2003;
91:293-5. doi:10.1046/j.1464-410X.2003.04065.x.

5. Douenias R, Rich M, Badlani G, Mazor D, Smith A. Predisposing factors in bladder calculi: Review of 100 cases. Urology. 1991; 37:240-3.

6. Papatsoris AG, Varkarakis I, Dellis A, Deliveliotis C . Bladder lithiasis: from open surgery to lithotripsy. Urol Res. 2006; 34:163-7. doi: 10.1007/s00240-006-0045-5.

7. Bhatvia, V, Biyani, CS. Extracorporeal Shock Wave Lithotripsy for Vesical Lithiasis: Initial Experience. Br J Urol. 1993; 37:695-699.

8. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187-96. doi: 10.1097/SLA.0b013e3181b-
9. Sofer M, Kaver I, Greenstein A, Bar Yosef Y, Mabjeesh NJ, Chen J, et al. Refinements in treatment of large bladder calculi: simultaneous percutaneous suprapubic and transurethral cystolithotripsy. Urology. 2004;
64:651-4. doi: 10.1159/000437213.

10. Philippou P, Moraitis K, Masood J, Junaid I, Buchholz N. The management of bladder lithiasis in the modern era of endourology. Urology. 2012; 79:980-6. doi: 10.1016/j.urology.2011.09.014.

11. Wollin TA, Singal RK, Whelan T, Dicecco R, Razvi HA, Denstedt JD. Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi. J Endourol. 1999; 13:739-44.

12. Torricelli FC, Mazzucchi E, Danilovic A, Coelho RF, Srougi M. Surgical management of bladder stones: literature review. Rev Col Bras Cir. 2013; 40:227-33. doi: 10.1590/S0100-69912013000300011.

13. Cicione A, De Nunzio C, Manno S, Damiano R, Posti A, Lima E, et al. Bladder stone management: an update. Minerva Urol Nefrol. 2018; 70:53-65. doi: 10.23736/S0393-2249.17.02972-1.

14. Tugcu V, Polat H, Ozbay B, Gurbuz N, Eren GA, Tasci AI. Percutaneous versus transurethral cystolithotripsy. J Endourol. 2009; 23:237-41. doi: 10.1089/end.2008.0455.

15. Deliktas H, Sahin H, Cullu N, Erdogan O. A modified technique for performing transurethral resection of the prostate combined with percutaneous cystolithotripsy. Urol Int. 2015; 95:276-80. doi: 10.1159/000437213.

16. Demirel F, Cakan M, Yalcinkaya F, Demirel AC, Aygun A, Altug UU. Percutaneous suprapubic cystolithotripsy approach: for whom? Why? J Endourol. 2006; 20:429-31. doi: 10.1089/end.2006.20.429.
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