TOPLINE

Transurethral cystolithotripsy was associated with complete stone clearance in more than 95% of patients and a shorter duration of hospital stay compared with percutaneous suprapubic or open surgery approaches. Complete stone clearance was also noted with open surgery.

METHODOLOGY

• Researchers utilized data from a prospective international registry including 805 patients who underwent an attempted surgical procedure for treating bladder stones at 31 centers across 16 countries (May 2025-February 2026).
• Interventions comprised transurethral intervention (n = 741), percutaneous suprapubic intervention (n = 39), or open surgery (n = 25) for bladder stones.
• Stone burden was assessed before surgery using CT, x-ray radiography, or ultrasonography; urine culture findings were also recorded for all patients.
• The primary outcome was stone-free rate post-surgery, assessed via imaging modalities or flexible cystoscopy and graded as grade A (100% stone-free with no residual fragments), grade B (single residual fragment), or grade C (multiple residual fragments).
• The secondary outcomes were comprehensive perioperative complications, specific intraoperative findings, and incidence of sepsis post-surgery.

TAKEAWAY

• Grade A stone-free status was achieved in 95.5% of patients who underwent transurethral intervention, 84.6% of those who underwent percutaneous suprapubic intervention, and 100% of those who underwent open surgery (P = .001).
• The median duration of hospital stay was significantly shorter after transurethral intervention than after percutaneous intervention or open surgery (2 days vs 3 days; P < .001), along with reduced time to catheter removal (P < .001).
• Complications within 48 hours occurred more frequently with open surgery than with transurethral intervention and percutaneous suprapubic intervention (48.0% vs 18.6% and 17.9%; P = .001); severe major complications were rare and similar across interventions.
• Repeat interventions to manage residual fragments were required more commonly after percutaneous suprapubic intervention (10.3%) than after transurethral intervention (1.3%) and open surgery (0%) (P < .001).

IN PRACTICE

"The technical data captured in the present study reinforce a broader, fundamental principle: success in bladder stone surgery depends far less on the pursuit of a single 'superior' energy technology than on correct, individualised route selection and the meticulous, complete evacuation of all generated fragments," the researchers wrote. "[The study] findings provide contemporary real-world insight into the selection and outcomes of different surgical approaches to bladder stones and support an individualised treatment strategy based on stone burden, patient anatomy, associated lower urinary tract pathology, and local surgical expertise," they added.

SOURCE

The study was led by Vineet Gauhar of the Department of Urology at Ng Teng Fong General Hospital in Singapore. It was published online on October 13 in the World Journal of Urology.

LIMITATIONS

The pragmatic observational methodology created an inherent selection bias, characterized by considerable numerical disparity between treatment arms, lack of randomized allocation, and institutional variation in instrumentation and perioperative protocols. Detailed technical information regarding concurrent procedures, including surgical approach, procedural sequence, and perioperative management strategies for combined interventions, was not captured in the registry.

DISCLOSURES

No specific funding was reported for this study. The authors reported no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.