Transurethral Versus Percutaneous Cystolithotripsy for Bladder Stones in Adults

This study evaluates and compares two minimally invasive surgical approaches for treating bladder stones in adult patients: transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL).

Urinary bladder stones are commonly managed using endoscopic techniques to avoid the morbidity of open surgery. TUCL accesses the bladder through the natural urinary channel (urethra), whereas PCCL accesses the bladder directly through a small puncture in the lower abdomen above the pubic bone. While both approaches are effective, comparative data in adult populations remain limited.

Eligible participants are randomly assigned to receive either TUCL or PCCL. The primary goal is to compare stone clearance rates and operative times between the two procedures. Secondary objectives include comparing surgical complication rates, duration of postoperative urinary catheterization, and length of hospital stay.

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Key information

Conditions

Urinary Bladder Calculi Bladder Calculi Calculi Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Male Urogenital Diseases Pathological Conditions, Anatomical Pathological Conditions, Signs and Symptoms Urinary Bladder Diseases Urinary Calculi Urogenital Diseases Urolithiasis Urologic Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Adult patients aged 18 years or older
Diagnosed with single or multiple urinary bladder stones
Stone diameter between 1 and 4 cm at its largest diameter or cumulative stone diameter
Candidates for both transurethral and percutaneous endoscopic treatment modalities

Exclusion criteria

Active urinary tract infection (UTI)
Uncorrected coagulopathy or bleeding disorders
Known urethral stricture or significant urethral pathology precluding safe transurethral instrumentation
History of bladder augmentation, major lower abdominal surgery, or pelvic radiotherapy
Concomitant bladder tumor or suspected bladder neoplasm
Stone located within a bladder diverticulum or within a contracted bladder
Requiring concomitant urological procedures during the same operative session (e.g., transurethral resection of the prostate [TURP] or lower ureteric stone extraction)
Urethral stones pushed back into the bladder
Refusal to participate in the study

Treatment and study plan

Transurethral Cystolithotripsy

Procedure

Under spinal or general anesthesia, a rigid cystoscope is introduced transurethrally under direct vision. Bladder calculi are visualized and fragmented using a Mauermayer stone punch and/or pneumatic lithotripter via a semirigid ureteroscope according to stone size and consistency. Stone fragments are evacuated using an Ellik evacuator and/or grasping forceps. Complete clearance and mucosal integrity are confirmed by cystoscopy, followed by insertion of a two-way urethral Foley catheter.

percutaneous cystolithotripsy

Procedure

Under spinal or general anesthesia, the bladder is distended retrogradely with 300-400 cc sterile irrigation fluid via cystoscopy. Under combined ultrasound and cystoscopic guidance, a midline suprapubic percutaneous puncture is executed using an 18G needle, followed by guidewire placement, tract dilation, and insertion of a 30 F Amplatz working sheath. A 26 F rigid nephroscope is introduced, and calculi are fragmented using a pneumatic lithotripter and removed with grasping forceps. A urethral Foley catheter is placed postoperatively, with or without a suprapubic tube based on intraoperative findings.

Primary outcomes

Stone-Free Rate

Time frame: 1 day

Stone-free status is defined as complete stone clearance or presence of clinically insignificant residual fragments (CIRF) <= 2 mm confirmed by direct endoscopic inspection.

Sponsors and collaborators

Lead sponsor

Assiut University

Other

Registry information

Official study title

Transurethral Versus Percutaneous Cystolithotripsy for the Management of Bladder Stones in Adults: A Prospective Randomized Comparative Study

Important dates

Study start: 2026
Primary completion: 2028
Study completion: 2028
First posted: Sep 9, 2026
Registry last updated: Sep 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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