Combined cystolithotomy and transurethral resection of prostate: best management of infravesical obstruction and massive or multiple bladder stones.
OBJECTIVE
To investigate the results of combined suprapubic cystolithotomy followed by transurethral resection (TUR) of the prostate (TURP) or TUR of the bladder neck in patients with infravesical obstruction and massive or numerous bladder stones. We also reviewed the medical literature and compared the success, morbidity, and mortality rates of the treatment modality presented here and the nonsurgical modality of transurethral lithotripsy and resection of the prostate or bladder neck.


METHODS
Through a 10-year period, 20 men with benign prostatic hyperplasia or bladder neck obstruction and massive or numerous bladder stones underwent cystolithotomy for stone clearance followed by TURP or TUR of the bladder neck. A second group of 20 randomly selected men who underwent TURP alone was studied retrospectively for time of surgery, number of days of postoperative indwelling catheter use, and hospital stay.


RESULTS
No deaths occurred. All stones were successfully evacuated (100% stone-free rate). The operative time and number of days of postoperative indwelling catheter use and hospital stay were notoriously shorter in the present series compared with the transurethral lithotripsy and TURP modality. A single case of fever (5% complication rate) occurred in each group. When comparing the data of the present series with a group of 20 men who underwent TURP only, no differences were found in the times of postoperative indwelling catheter use and hospital stay. Cystolithotomy performed before TURP prolonged the total time of surgery an average of 18.4 minutes.


CONCLUSIONS
In the era of endoscopic and minimally invasive surgery, a small suprapubic cystostomy followed by TURP is still the treatment of choice in cases of infravesical obstruction and very large or numerous bladder stones. The procedure is quick and easy to perform and bears a low morbidity rate compared with transurethral lithotripsy and TURP. A small cystotomy does not prolong the time of indwelling catheter use and hospital stay.
Richter
Santiago
S
Department of Urology, Sapir Medical Center, Kfar Sava, University of Tel Aviv Sackler Faculty of Medicine, Tel Aviv, Israel.
Ringel
Avi
A
Sluzker
David
D
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D003559:Cystostomy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D001744:Urinary Bladder Calculi / Q000150:complications / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000601:surgery*