A randomized trial comparing transurethral to percutaneous cystolithotripsy in boys

To compare between transurethral cystolithotripsy and percutaneous cystolithotripsy in the management of bladder stones in male children regarding efficacy and morbidity.

One hundred boys younger than 14 years with a single bladder or urethral stone less than 30 mm were randomized into two equal groups. Initial diagnostic urethro-cystoscopy and push back of urethral stones were done for patients in both groups. Patients in group A had transurethral cystolithotripsy, while those in group B had percutaneous cystolithotripsy through a 20-Fr sheath using a 12-Fr nephroscope. The two groups were compared regarding preoperative criteria, intraoperative details and postoperative outcomes.

The patients in this study had a median (range) age of 36 (4—144) months and a median (range) stone size of 10 (5—26) mm. There was no statistically significant difference between the two groups regarding preoperative criteria. The assigned procedure was successful in 48(96%) patients in group A and 49 (98%) patients in group B (p = 1). Complications were encountered in 11(22%) patients in group A and five (10%) patients in group B (p = 0.171). The median (range) operative time was 21.5 (4—90) minutes in group A and 13 (5—70) minutes in group B (p < 0.001). Forty seven (94%) stones needed disintegration in group A versus 22 (44%) in group B (p < 0.001).

Both techniques have comparable success and complications rates. However, percutaneous cystolithotripsy has a shorter operative time and less need for stone disintegration.