Treatment of bladder stones without associated prostate surgery: Results of a prospective study

doi:10.1016/j.urology.2005.03.072

Urology

Volume 66, Issue 3, September 2005, Pages 505-509

https://doi.org/10.1016/j.urology.2005.03.072 Get rights and content

Abstract

Objectives

To assess the effectiveness of noninvasive bladder lithiasis treatment without associated prostate surgery to know whether bladder lithiasis is an absolute indication for prostate surgery.

Methods

Fifty patients with bladder lithiasis were entered in a prospective trial and were treated with extracorporeal shock wave lithotripsy if lithiasis was smaller than 4 cm². Independent of the presence or absence of bladder outlet obstruction, in no case was prostate surgery associated. The variables studied were the effectiveness of the treatment, changes in the International Prostate Symptom Score (IPSS), and the subsequent need for desobstructive prostate surgery. The statistical study was performed using Student’s t test and the proportional hazards model.

Results

Bladder lithiasis was successfully eliminated in 93% of the cases (in 77% of them with a single extracorporeal shock wave lithotripsy session). The mean IPSS decreased from 17.7 to 9.7 points (P = 0.0001) after lithiasis elimination. After a mean follow-up of 22 months, a mere 8% of the patients needed subsequent prostate surgery because their IPSS had increased to 20 points or more. The sole prognostic factor for the need for ensuing prostate surgery was the pretreatment IPSS score (P = 0.042).

Conclusions

Noninvasive management of bladder lithiasis with no associated prostate surgery is highly efficient and results in marked symptomatic improvement. Furthermore, the number of patients needing subsequent prostate surgery was very low at mid-term follow-up. Because of all of the above, the existence of bladder lithiasis is not an absolute indication for prostate surgery.

Section snippets

Patients

A total of 50 patients were included who had received a diagnosis of bladder lithiasis in the course of a prospective trial. Their characteristics and the inclusion and exclusion criteria have been previously published.¹⁴

Patient Treatment

The following explorations were performed at the inclusion visit: plain radiology and ultrasonography; urinalysis and prostate-specific antigen measurement; the International Prostate Symptom Score (IPSS)¹⁵; and two physiologic uroflowmetry studies and one urodynamic study to

Results

Baseline data are presented in Table I. According to the bladder lithiasis size, 3 patients were treated with transurethral endoscopic lithotripsy, 2 with cystolithotomy, and the rest with ESWL; in no case was BPH surgery performed. The patients treated with ESWL received a mean 4158 impulses (95% CI 3440 to 4875) at a 7.44 kV energy peak (95% CI 6.8 to 8). Of the patients undergoing ESWL, 77% of patients needed only one session, 18% needed two, and 5% needed three. Complete elimination of

Comment

Since 1990, several works have been published on the management of bladder lithiasis using ESWL.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 However, some differences exist regarding the types of treatment and the kinds of machine used. Some patients were treated with a Siemens Lithostar lithotriptor,1, 2, 4, 6, 7, 13 others with a Dornier HM3,3, 8 a Dornier MPL 9000,5, 10, 11, 12 or a Dornier HM4.⁹ Our group used the Siemens Lithostar Ultra lithotriptor whose ultrasonography focalization allows

Conclusions

One of the most significant aspects of this study was that our patients were treated with ESWL only, without an invasive procedure and without anesthesia. We achieved a 93% effectiveness rate using a purely physiologic, noninvasive approach, with neither previous nor ensuing endoscopic maneuvers. This method has been shown to obtain complete expulsion of the stone fragments. The results of our study have shown that it is not necessary to add surgical treatment of BPH. Thus, the existence of

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Cited by (27)

Simultaneous antegrade and retrograde endoscopic surgery for benign prostatic hyperplasia with vesical calculi – A single-centre experience
2018, Arab Journal of Urology
Citation Excerpt :
However, some authors have questioned this dogma by the use of shockwave lithotripsy for the management of BPH with bladder calculi. Millán-Rodríguez et al. [6] reported a stone-free rate of 93% when treating 50 patients with bladder stones and BPH in a prospective study, and concluded that the pre-treatment IPSS was the single most predictive factor for the need for prostatic surgery. However, further validation of this hypothesis by prospective randomised studies is required.
To describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi.
This was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient’s symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications.
The mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days.
Simultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible.
Endoscopic Approach to Bladder Stones
2016, Endoscopic Diagnosis and Treatment in Urinary Bladder Pathology: Handbook of Endourology
Bladder stones have been recognized and treated since ancient times. The appearance of the first variants of lithotomy identified urology as a distinct medical specialty. Bladder stones can be classified according to their origin and the mechanism of formation into migrating, primary (idiopathic), or secondary stones. Introduced by Bigelow, transurethral cystolitholapaxy was performed by tactile lithotripsy until the late 1800s. Technological advances, including both modern instruments and energy sources for achieving an increasingly efficient and less aggressive fragmentation, have significantly improved this procedure.
Conservative Treatment for Benign Prostatic Hyperplasia in Patients with Bladder Stones
2015, Urology
Citation Excerpt :
One possible reason for the success of nonsurgical treatment in these patients is that the cause of their urinary symptoms may have been the bladder stones themselves rather than BPH. Millan-Rodriguez et al9 reported a mean IPSS reduction of 8 points and a mean QOL score improvement of 2.1 in 50 patients prospectively treated with extracorporeal shock wave lithotripsy without medical treatment for BPH 1 month after stone elimination. Other studies reported that 65% of patients with BPH managed with watchful waiting experienced worsening of LUTS, with 36% undergoing surgery within 5 years.10,11
To determine whether conservative management of benign prostatic hyperplasia (BPH) is an appropriate option for patients with bladder stones.
The study cohort comprised 34 men who underwent endoscopic bladder stone removal with subsequent conservative management of BPH, including watchful waiting and medical therapy (alpha-blocker ± dutasteride), between April 2006 and January 2014. We recorded BPH-related complications after stone removal and compared International Prostate Symptom Scores, quality of life scores, and postvoid residual urine volume before and after treatment. Cumulative BPH-related complication-free survival and the preoperative parameters associated with the occurrence of BPH-related complications were also analyzed.
Twenty-six patients (76.5%) treated with conservative management had no BPH-related complications, during a mean follow-up of 52.6 ± 30.9 months. Mean International Prostate Symptom Scores fell from 13.5 ± 7.1 before treatment to 9.7 ± 6.3 after treatment (P = .025). One of the 34 patients (2.9%) experienced recurrent urinary infections, 2 (5.9%) had urinary retention, and 6 (17.6%) developed recurrent bladder stones. The cumulative BPH-related complication-free survival was 97.0% at 1 year, 81.8% at 3 years, and 70.5% at 5 years. Six of the men (17.6%) underwent invasive intervention for BPH after occurrence of these complications. Prostate volume was the only preoperative parameter associated with the occurrence of complications after stone removal (P = .035).
Conservative management of BPH can be an appropriate treatment option in men with bladder stones and concurrent mild-to-moderate lower urinary tract symptoms.
Benign prostatic hyperplasia
2014, Surgery (United Kingdom)
Male lower urinary tract symptoms (LUTS) have a multifactorial aetiology and are not simply solely due to bladder outflow obstruction (BOO) from benign prostatic hyperplasia (BPH). Other causes of LUTS include bladder dysfunction, malignant prostatic disease, urethral disease and medical conditions such as polyuria. Complications from BPH include acute urinary retention, urinary tract infection and haematuria. Following investigation, men are treated with medical therapy for BPH using α-blockers and 5α-reductase inhibitors. Some men undergo surgery for their symptoms and this can be in the form of open prostatectomy, transurethral resection of the prostate (TURP) and a variety of laser ablating and enucleating techniques.
Reply by the authors
2013, Urology
Shock wave lithotripsy of vesical stones in patients with infravesical obstruction: An underused noninvasive approach
2013, Urology
Citation Excerpt :
Since then, the role of SWL in managing vesical stones in patients with prostatic disease has been poorly investigated in urologic studies. In 2 contradictory reports published in 2005, Al-Ansari et al4 considered the presence of benign prostatic hyperplasia as a contraindication for SWL, and Millan-Rodriguez et al3 reported excellent clinical outcomes and symptomatic improvement after isolated SWL without prostatectomy and achieved a 93% effectiveness rate with complete stone expulsion. The clearance of stone fragments after the therapy is controversial.
To evaluate the effectiveness and safety of shock wave lithotripsy in the management vesical stones in patients with infravesical obstruction.
From March 2007 to April 2010, 59 male patients with infravesical obstruction were treated using the Dornier Compact Delta II Lithotriptor for urinary bladder stones. The indications for shock wave lithotripsy included patients refusing invasive procedures or those with orthopedic malformations hindering the lithotomy position. The mean age was 61.6 ± 8.6 years (range 44-78), and the mean body mass index was 29 ± 5.1 kg/m² (range 20.5-45). The mean stone diameter was 26.6 ± 9.8 mm (range 12-50). All patients underwent an initial session and were re-evaluated using ultrasonography and urinary tract plain radiography at 2-week intervals.
All patients were treated in the supine position. The number of shocks ranged from 1910 to 9500. Of the 59 patients, 47 and 11 were cleared by 1 or 2 sessions, respectively; 1 patient required a third session to be cleared of stones. All patients develop mild hematuria and started to pass gravel in the first void after the shock wave lithotripsy session. All patients were rendered stone free within 6 weeks. During follow-up, only 2 male patients developed temporary acute urine retention necessitating urethral catheter fixation. Both patients had a neurologic insult.
Extracorporeal shock wave lithotripsy is an effective, noninvasive approach to disintegrate vesical stones in patients with infravesical obstruction with adequate fragment clearance.

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Adult urologyTreatment of bladder stones without associated prostate surgery: Results of a prospective study

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Patients

Patient Treatment

Results

Comment

Conclusions

J Urol

J Urol

J Urol

Actas Urol Esp

J Urol

Urol Clin North Am

Urology

Urology

Litotricia extracorpórea por ondas de choque (LEOC) en el tratamiento de la litiasis vesical. Una nueva opción terapéutica

Actas Urol Esp

Extracorporeal shock wave lithotripsy for vesical lithiasisinitial experience

Br J Urol

Extracorporeal shock wave lithotripsy for bladder stones

Br J Urol

Adult urology
Treatment of bladder stones without associated prostate surgery: Results of a prospective study