Transurethral Versus Percutaneous Cystolithotripsy for Bladder Stones in Adults
Transurethral Versus Percutaneous Cystolithotripsy for the Management of Bladder Stones in Adults: A Prospective Randomized Comparative Study
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.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
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
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Group A: Transurethral Cystolithotripsy (TUCL)
Participants undergo transurethral cystolithotripsy under spinal or general anesthesia.
A rigid cystoscope is introduced through the urethra under direct vision.
Bladder calculi are visualized and fragmented using a Mauermayer stone punch and/or pneumatic lithotripter via a semirigid ureteroscope.
Stone fragments are evacuated using an Ellik evacuator and/or grasping forceps.
Stone clearance and mucosal integrity are confirmed by cystoscopy, followed by insertion of a two-way urethral Foley catheter.
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Under spinal or general anesthesia, a rigid cystoscope is introduced transurethrally under direct vision.
Bladder calculi are visualized and fragmented using a Mauermayer stone punch and/or pneumatic lithotripter via a semirigid ureteroscope according to stone size and consistency.
Stone fragments are evacuated using an Ellik evacuator and/or grasping forceps.
Complete clearance and mucosal integrity are confirmed by cystoscopy, followed by insertion of a two-way urethral Foley catheter.
|
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Aktiv komparator: Group B: Percutaneous Cystolithotripsy (PCCL)
Participants undergo percutaneous cystolithotripsy under spinal or general anesthesia.
The bladder is filled retrogradely with 300-400 cc of sterile irrigation fluid via cystoscopy.
Under ultrasound and cystoscopic guidance, a midline suprapubic puncture is performed with an 18G needle, followed by guidewire insertion, fascial dilation, and placement of a 30 F Amplatz sheath.
Stones are fragmented with a pneumatic lithotripter via a 26 F nephroscope and extracted with grasping forceps.
Postoperative drainage includes a urethral Foley catheter (with or without a suprapubic catheter).
|
Under spinal or general anesthesia, the bladder is distended retrogradely with 300-400 cc sterile irrigation fluid via cystoscopy.
Under combined ultrasound and cystoscopic guidance, a midline suprapubic percutaneous puncture is executed using an 18G needle, followed by guidewire placement, tract dilation, and insertion of a 30 F Amplatz working sheath.
A 26 F rigid nephroscope is introduced, and calculi are fragmented using a pneumatic lithotripter and removed with grasping forceps.
A urethral Foley catheter is placed postoperatively, with or without a suprapubic tube based on intraoperative findings.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Stone-Free Rate
Tidsramme: 1 day
|
Stone-free status is defined as complete stone clearance or presence of clinically insignificant residual fragments (CIRF) <= 2 mm confirmed by direct endoscopic inspection.
|
1 day
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Mandlige urogenitale sygdomme
- Calculi
- Patologiske Tilstande, Anatomiske
- Urologiske sygdomme
- Urogenitale sygdomme hos kvinder
- Kvinders urogenitale sygdomme og graviditetskomplikationer
- Urinvejsregning
- Urinblæresygdomme
- Patologiske tilstande, tegn og symptomer
- Urolithiasis
- Urinblæren Calculi
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- TUCL vs PCCL for Bladder Stone
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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