Retrograde-assisted Percutaneous Cystolitholapaxy versus Transurethral Cystolithotripsy with Holmium-YAG Laser, A Retrospective Study

Abstract Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho:YAG).Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 μm fiber vaporize the stone.Results: A total of 124 male patients with the mean age of 50.33 ± 9.64 years and the average stone burden of 3.35 ± 1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P ≤ 0.05) and the mean hospital stay in favor of the TULL group (P ≤ 0.05). The stone-free rate (SFR) was 100% in both methods after a one month follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods.Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable inmedical centers without Ho: YAG equipment. Keywords: Bladder stone Bladder calculi Percutaneous cystolitholapaxy Transurethral cystolitholapaxy Holmium-YAG laser