RESUMO
To describe our experience in the management of primary and secondary urinary bladder stone, we use different options of surgical intervention for clearance of the stones. Between January 2005 and May 2009, we treated 242 patients with urinary bladder stones in our center, 208 males and 34 females. Transurethral cystolitholapaxy was the first option for single stone less than 4cm and multiple stones each less than 2cm. Open cystolithotomy was performed in presence of hard stone more than 4cm and in presence of concomitant huge obstructing prostate > 100gm or bladder surgery. Percutaneous suprapubic cystolithotripsy was performed among pediatric age group and patients with permenant cystostomy. Extracorporeal shockwave lithotripsy was a reserved for high risk patients. Out of 242 patients, 190 patients underwent transurethral cystolitholapaxy; Transurethral Resection of Prostate and optical urethrotomy were performed among 105 patients [55.3%]. Presence of foreign bodies as in retained ureteral stents, eroded tension free vaginal tape mesh, suture materials were main causes of the rest of the patients. The duration of urethral catheterization was 24-48 hours, complete clearance was achieved in 185 patients [97.4%], complications were detected in 24 patients [12.6%], hematurea and transient pyrexia were the main complications. Cystolithotomy was performed in 35 patients, concomitant open prostatectomy in 15 cases, bladder diverticulectomy in two cases and 18 cases excluded from cystolitholapaxy criteria. The mean duration of urethral catheterization was 9 days [average 5-14 days] and wound infection was the commonest complication. Percutaneous suprapubic cystolithotripsy was done in 11 cases, failure occurred in one patient [9%], the average duration of catheterization was 3 days and transient pyrexia was detected in two [18%]. Extracorporeal shockwave lithotripsy was a first option in 6 high risk patients with stone clearance rate 83% and significant hematurea occurred in one patient. Transurethral cystolitholapaxy offers the first choice of management for single urinary bladder stones less than 4cm, and multiple small bladder stones. Percutaneous suprapubic cystolithotripsy is a safe procedure and it is an option of management in pediatric age group and in patients with permenant cystostomy. Extracorporeal shockwave lithotripsy can be used in high risk patients. In concomitant prostate or bladder surgery and in hard stones or stones that are more than 4cm, Open surgery is the first treatment of choice