Prospective randomized comparison of three endoscopic modalities used in treatment of bladder stones

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).

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.

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).

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.