Percutaneous versus transurethral cystolithotripsy and TURP for large prostates and large vesical calculi: Refinement of technique and updated data |
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Authors: | Monish Aron Rajiv Goel Gagan Gautam Amlesh Seth Narmada P Gupta |
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Institution: | (1) Department of Urology, All India Institute of Medical Sciences, 110029, New Delhi, India |
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Abstract: | Background and purpose: We compare two modalities of treatment; transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL),
for large vesical calculi in patients who underwent simultaneous transurethral resection of prostate (TURP), and present refinements
of the technique of PCCL. Patients and methods: Between July 1999 and June 2003, 54 patients were subjected to either TUCL (n = 19) or PCCL (n = 35) along with simultaneous TURP. Inclusion criteria were prostate volume > 50 ml, aggregate stone size > 3 cm with each
individual stone > 1 cm, In the TUCL group, calculi were treated with 26F nephroscope, pneumatic lithotripsy and fragment
extraction. This was followed by TURP with 26F continuous-flow resectoscope. In the PCCL group, calculi were removed through
a suprapubic 30F Amplatz sheath followed by standard TURP with the suprapubic sheath in situ to provide continuous drainage.
A 20F two-way Foley catheter was inserted suprapubically and urethrally in cases of PCCL and a 22–24F three-way catheter urethrally
after TUCL. Results: The two groups were comparable in age. The mean prostate size as well as aggregate stone size was significantly larger in
PCCL group. The operating time for stone removal was significantly less in the PCCL group while time required for TURP was
statistically similar in two groups. In the TUCL arm three patients had residual stones requiring repeat TUCL, and one developed
a urethral stricture.Conclusions: Combined TURP and PCCL is safe, more effective and a much faster alternative to combined TURP and TUCL in patients with
large bladder calculi and large prostates. |
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Keywords: | Calculi Cystolithotripsy Percutaneous TURP Vesical |
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