A comparative study of cystolithotripsy and extracorporeal shock wave therapy for bladder stones

Abstract

This study compares the safety and efficacy of mechanical cystolithotripsy (MCLT) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of vesical stones. In the last four years we have treated 144 bladder lithiasis patients with MCLT (86; group A) and ESWL (58; group B). All patients in group A were treated under spinal anaesthesia while 47 patients in group B needed intravenous sedation. The early complication rates in groups A and B were 19.7 and 6.8%, respectively. The corresponding mean hospital stay was 60 and 18 hours. ESWL should be considered as an effective, safe and least invasive alternative to MCLT in the therapeutic options for vesical lithiasis.

Comparison of Transurethral use of Nephroscope with Cystoscope in Transurethral Cystolithotripsy

“…Today it is a rarely used method. In recent studies, comparing the effectivity of OC with endourological procedures in treating large bladder stones, it was concluded that OC has a 100% stone-free rate at one setting, similar operation time but a longer hospital stay [9,11]. Nowadays, OC should be the main treatment modality in patients with heavy stone burden, abnormal anatomy preventing safe access for endourological methods or who are undergoing open prostatectomy and diverticulectomy [12,13].…”

“…These minimally invasive surgical procedures significantly increased the success rates of bladder stone treatment however, complication rates and operation time change according to the treatment modality. In these surgical techniques, bladder stones were removed via transurethral or suprapubic routes [9]. Generally, intervention through transurethral way is made by using a cystoscope or nephroscope [10].…”

“…Stone size and constituent, patient's age, previous history of treatment for bladder stones, body structure of the patient, accompanying diseases, treatment cost and preference of the surgeon are the factors used for determining the treatment modality [5]. Several lithotripsy devices such as electro-hydraulic, holmium laser, ultrasonic and pneumatic lithotripters are used for the endoscopic fragmentation of bladder stones [6][7][8][9]. Despite this variety of operative approaches and modalities of lithotripsy, the management of large calculi can sometimes be challenging and time consuming.…”

Management of bladder stones: the move towards non-invasive treatment

“…9 Secondly, there has also been some controversies regarding the proper patient positioning during the ESWL session. Some authors suggested a prone position 17 while others recommended conducting the session in a supine position. 10 Some authors prefered supine position because they assumed that in prone position, the sacrum might hinder stone fragmentation to some extent.…”

“…Additionally, transurethral approach also has several additional disadvantages such as longer operating time, hematuria, risk of bladder perforation, and potential urethral injury as their disadvantages. 7,17 ESWL, on the contrary, is a non-invasive modality that utilizes high energy acoustic pulses generated outside the body. 18 The effective applications of ESWL in disintegrating both radiopaque and radiolucent renal stones (e.g.…”