Bladder calculi: clearance rates and early complications after shock wave lithotripsy versus those after transurethral endoscopic manipulations

ABSTRACT

Extracorporeal shock wave lithotripsy [ESWL] and transurethral endoscopic extraction with or without pneumatic fragmentation have been the most commonly applied procedures at our institution for the treatment of bladder stones. Through this work we aimed to evaluate and compare the results of both procedures during the past 5 years as regards the stone-clearing capabilities and the incidence of peri-operative complications. The peri-operative data and imaging studies of 88 patients who underwent ESWL for their bladder stones as well as 74 patients who had transurethral extraction with or without pneumatic fragmentation were revised [groups A and B, respectively]. Children in either groups were analyzed separately while adults were sub-classified according to their stone sizes [small, medium or large]. A stone-free status was judged if there were no residual fragments larger than 5 mm in adults and larger than 3 mm in children. Each of the subgroups in one treatment arm was compared statistically to its counterpart in the other treatment arm as regards stone clearance rate and complications. Student-t and chi-square tests were applied. ESWL rendered 76.9% of 26 children stone-free while all 4 children who were treated endoscopically were cleared of their stones. Stone clearance rates in adults who underwent ESWL were 83.3, 88.9 and 50% for small, medium and large stones, respectively. The equivalent figures in group B were 96.2, 89.5 and 68%. Although transurethral therapy appeared more successful particularly in small stones, yet there has been no statistical significance between either treatment modalities. On the other hand, the incidence of complications was significantly higher in group B adults. These included for instance, 2 patients with bladder injuries, 8 with moderate to severe haematuria and 5 with urethral injuries. These results indicate that transurethral endoscopic extraction [with or without pneumatic fragmentation] of small bladder stones yielded better clearance rates than ESWL although this was not statistically significant. Both modalities were almost equivalent at clearing medium sized stones but ESWL fared better as regards safety. The results in large stones were not only fair, but they also carried a high rate of complications particularly with the endoscopic access