Transurethral Versus Percutaneous Cystolithotripsy for Bladder Stones in Adults

This study evaluates and compares two minimally invasive surgical approaches for treating bladder stones in adult patients: transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL). Urinary bladder stones are commonly managed using endoscopic techniques to avoid the morbidity of open surgery. TUCL accesses the bladder through the natural urinary channel (urethra), whereas PCCL accesses the bladder directly through a small puncture in the lower abdomen above the pubic bone. While both approaches are effective, comparative data in adult populations remain limited. Eligible participants are randomly assigned to receive either TUCL or PCCL. The primary goal is to compare stone clearance rates and operative times between the two procedures. Secondary objectives include comparing surgical complication rates, duration of postoperative urinary catheterization, and length of hospital stay.

Inclusion Criteria: * Adult patients aged 18 years or older * Diagnosed with single or multiple urinary bladder stones * Stone diameter between 1 and 4 cm at its largest diameter or cumulative stone diameter * Candidates for both transurethral and percutaneous endoscopic treatment modalities Exclusion Criteria: * Active urinary tract infection (UTI) * Uncorrected coagulopathy or bleeding disorders * Known urethral stricture or significant urethral pathology precluding safe transurethral instrumentation * History of bladder augmentation, major lower abdominal surgery, or pelvic radiotherapy * Concomitant bladder tumor or suspected bladder neoplasm * Stone located within a bladder diverticulum or within a contracted bladder * Requiring concomitant urological procedures during the same operative session (e.g., transurethral resection of the prostate \[TURP\] or lower ureteric stone extraction) * Urethral stones pushed back into the bladder * Refusal to participate in the study