INTRODUCTION: The aim of this study was to compare three endoscopic modalities used in the treatment of bladder stones: transurethral use of cystoscope or nephroscope and percutaneous cystolithotripsy (PCCL). METHODS: This study included 210 patients of bladder stone treated at a tertiary care centre in North India from January 2006 to July 2013 who were randomly assigned into three groups: group 1 (transurethral removal using cystoscope), group 2 (transurethral removal using nephroscope) and group 3 (PCCL). Baseline and perioperative data wererecorded and compared between three groups. RESULTS: Baseline parameters were comparable between the three groups. Operating time in group 2 was significantly less than the other two groups. Complete clearance was achieved in all the patients. Group 2 had maximum number of urethral entries. The incidence of perioperative complications (fever, transient haematuria and persistent leakage from suprapubic site) was comparable between these three groups. Till the last follow-up, 3.2% patients (n = 2) developed urethral stricture in group 1, 7.8% (n = 5) in group 2 and no patient developed urethral stricture in group 3 (p = 0.068). CONCLUSIONS: Removal of bladder stones by the transurethral route, using a nephroscope, is the most effective treatment modality in terms of operative time with long-term urethral stricture rate similar to transurethral cystoscope technique. Comparatively, PCCL is a safe procedure with acceptable morbidity. Overall, all three techniques are equally efficacious in treating bladder stones of size 1-4 cm.
RCT Entities:
INTRODUCTION: The aim of this study was to compare three endoscopic modalities used in the treatment of bladder stones: transurethral use of cystoscope or nephroscope and percutaneous cystolithotripsy (PCCL). METHODS: This study included 210 patients of bladder stone treated at a tertiary care centre in North India from January 2006 to July 2013 who were randomly assigned into three groups: group 1 (transurethral removal using cystoscope), group 2 (transurethral removal using nephroscope) and group 3 (PCCL). Baseline and perioperative data wererecorded and compared between three groups. RESULTS: Baseline parameters were comparable between the three groups. Operating time in group 2 was significantly less than the other two groups. Complete clearance was achieved in all the patients. Group 2 had maximum number of urethral entries. The incidence of perioperative complications (fever, transient haematuria and persistent leakage from suprapubic site) was comparable between these three groups. Till the last follow-up, 3.2% patients (n = 2) developed urethral stricture in group 1, 7.8% (n = 5) in group 2 and no patient developed urethral stricture in group 3 (p = 0.068). CONCLUSIONS: Removal of bladder stones by the transurethral route, using a nephroscope, is the most effective treatment modality in terms of operative time with long-term urethral stricture rate similar to transurethral cystoscope technique. Comparatively, PCCL is a safe procedure with acceptable morbidity. Overall, all three techniques are equally efficacious in treating bladder stones of size 1-4 cm.