title: Percutaneous versus transurethral cystolithotripsy.
abstract: OBJECTIVE
  To compare transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL) modalities performed during simultaneous transurethral resection of the prostate (TURP) in patients with prostate hyperplasia and large bladder stones.
  
  
  METHODS
  Sixty-three patients with prostate volume >40 cc and aggregate stone size >2.5 cm were enrolled in the study between August 2003 and February 2007. TUCL (n = 38) or PCCL (n = 25) procedures were performed during simultaneous TURP. In the TUCL group, the stones were removed after fragmentation through a 23F cystolithotripter with pneumatic lithotripsy. This was followed by TURP, performed with a 26F continuous-flow resectoscope. In the PCCL group, the stones were removed through a suprapubic 30F Amplatz sheath after fragmentation. TURP was then performed with the suprapubic sheath providing continuous drainage.
  
  
  RESULTS
  Mean age and prostate volumes of the groups were similar. Mean aggregate stone sizes were significantly larger in the PCCL group. The operative time for stone removal was significantly less in the PCCL group while time needed for TURP was statistically similar in the two groups. In the TUCL group, three patients had residual stones necessitating repeated TUCL and urethral stricture developed in three patients.
  
  
  CONCLUSIONS
  The smaller caliber of the working channel during TUCL, compared with PCCL, necessitates disintegration of the stones into smaller fragments. This elongates the duration of the intervention and results in increased urethral and bladder trauma. Combined TURP and PCCL is a safer, more effective, and much faster alternative to combined TURP and TUCL in patients with large bladder stones and prostate hyperplasia.
authors.affiliation: Department of Urology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey. volkantugcu@yahoo.com
authors.forename: Volkan
authors.initials: V
authors.lastname: Tugcu
authors.forename: Hakan
authors.initials: H
authors.lastname: Polat
authors.forename: Bedi
authors.initials: B
authors.lastname: Ozbay
authors.forename: Necati
authors.initials: N
authors.lastname: Gurbuz
authors.forename: Gulay A
authors.initials: GA
authors.lastname: Eren
authors.forename: Ali I
authors.initials: AI
authors.lastname: Tasci
mesh_terms: D000368:Aged; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D011182:Postoperative Care; D011859:Radiography; D020728:Transurethral Resection of Prostate; D014521:Urethra / Q000601:surgery*; D001744:Urinary Bladder Calculi / Q000000981:diagnostic imaging