Transurethral Cystolithotripsy For Large Vesical Calculi

Abstract

Objective: To asses efficacy and safety of transurethral cystolithotripsy in the management of
large vesical calculi.
Material and Methods: Adult patients with large vesical calculi (>2.5cm) were selected for this
prospective study. Patients with associated urethral stricture and big adenomas were excluded.
Stone size was measured on ultrasound in the largest diameter. Patients were operated under
spinal or general anaesthesia. Nephroscope with 28 fr sheath was used transurethrally along with
2 cm lithoclast probe. Initial fragmentation was achieved with Swiss lithoclast. Later bigger
fragments were dealt with stone punch. In the end all fragments were evacuated with Ellick
evacuater. Bladder was drained with Foley catheter for 24 hours. TURP (transurethral resection
of prostate) was done if required. Patients with bigger glands were excluded to restrict operating
time. Patients were followed up for two weeks.
Results: Forty patients were selected. Mean age of the patients was 55 years (range 18-73
years). There were 32 males (80%) and 8 females (20%). Mean+ SD stone size was 4.72+ 2.52
cm with range of 2.5-7.0 cm. five patients had multiple stones, four of them had associated
neurogenic bladder. Procedure time ranged from 20-90 minutes (mean 45.8 minutes). Complete
fragmentation of calcululi was achieved in all patients. Twelve patients underwent TURP under
same anaesthesia. Time consumed on resection of prostate was not included in procedure time.
There were no major complications.
Conclusion: Transurethral cystolithotripsy is very effective and safe for large vesical calculi
(>2.5cm). It is time consuming but saves patients from hazards of open surgery.