comparing   efficacy and complications of transurethral lithotripsy and cystolitholopaxy in the treatment of bladder stones less than 20 mm.

In this randomized clinical trial, 75 patients over 18 years of age with bladder stones referred to the operating room of Shahadaie gomnam Hospital, who were candidates for cystolithopaxy through the urethra and endoscopic stone crushing (TUL) (stones smaller than 20 mm) were included. Were studied. History and complete physical examination and basic serum tests including PT, PTT, CBC, Hb, Na, K, kidney function tests (BUN, Cr) and complete urine test and urine culture were performed on all patients. In group 1 (transurethral lithotripsy), after prep, the patient was placed under spinal anesthesia or general anesthesia with the help of an anesthesiologist in a lithotomy position. Then, Ureteroscopy was performed with a standard method, and the stone was broken into small and disposable pieces, and then the bladder was irrigated with a cystoscope sheet and normal saline to remove the pieces. At the end of the operation, if needed, a Foley duct was placed and the operation time was recorded. In the second group (Supine), spinal anesthesia or general anesthesia was performed, similar to the first group and in the lithotomy position, the stone was crushed using litholopaxy and its parts were removed by washing or litholopaxy, and at the end of the operation, Foley was placed in the bladder. In case of any unwanted vascular, visceral, pulmonary or cardiac complications, operation  was terminated and standard treatment were performed. After the surgery, the patients  were hospitalized for one to two days, and if there was no fever, pain Abdomen, ileus and gross hematuria they were discharged.

Seventy-five patients with bladder stones were examined. Of these, 35 people were in the cystolitholapaxy group and 40 people were in the TUL group. Of these, 97.1% were men in the cystolitholapaxy group and 70% were men in the TUL group. The length of hospitalization in the cystolitholapaxy group was 1.41 days and in the TUL group was 0.82 days. In terms of gender, operation efficacy and stone size, a statistically significant difference was observed between the two groups.In terms of age, gender, operation efficiency and stone size, a statistically significant difference was observed between the two groups.

Bladder stones account for approximately 5% of all urinary stones , with unique predisposing factors in different age groups and genders. In the past, the standard management of bladder stones involved the removal of the stones along with surgical treatment for prostatic obstruction, as the cause of bladder stones was believed to be bladder outlet obstruction. Later, the development of endourology allowed for the fragmentation of stones and the removal of prostatic obstruction through endoscopic resection via the urethra. In recent decades, various techniques for managing bladder stones have been developed, including open cystolithotomy, transurethral cystolitholapaxy, SWL (shock wave lithotripsy), and percutaneous cystolitholapaxy.in this study the operation time was similar and there was no significant complication in both groups .

Conclusion: The treatment of bladder stones smaller than 20 mm by cystolithopaxy method is a safe and effective treatment method compared to TUL and it is more effective than TUL and can be used as the main treatment especially in adults and people with normal urethra.

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