The randomized comparison of two different endoscopic techniques in the management of large bladder stones: transurethral use of nephroscope or cystoscope?

Purpose: Endoscopic treatment of large bladder stones via cystoscope is still bothersome, and open cystolithotomy is the preferred method in many centers. To gain more insight into the endoscopic bladder stone management, we aimed to compare the transurethral use of nephroscope and cystoscope randomly.

Patients And Methods: Forty-three male patients with bladder stones were randomized into two groups, to perform nephroscopic (group 1, n = 22) and cystoscopic (group 2, n = 21) stone fragmentation procedures transurethrally. Combined pneumatic/ultrasonic lithotripsy device was used in both groups to fragment the bladder stones.

Results: The mean stone size in group 1 and group 2 was 3.6 +/- 1.3 cm and 3.5 +/- 1.6 cm, respectively (p > 0.05). Stone fragments were removed completely in all of the patients, and the mean operation time was calculated as 48.2 +/- 13.2 minutes in group 1 and 68.1 +/- 22.7 minutes in group 2, with no intraoperative complications (p < 0.01). None of the patients developed urethral stricture disease in the early (postoperative third month) follow-up. Three patients with previously known urethral stricture disease have shown to have the same disease in the late (postoperative 14.4 +/- 5.1 months) follow-up.

Conclusion: Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.