Comparison of Surgical Outcomes for Bladder Stones in Geriatric Patients: Open Cystolithotomy, Percutaneous and Transurethral Cystolithotripsy Techniques.

Abstract

Background: Bladder stones feature multifactorial aetiologies, including bladder outlet obstruction, metabolic or genetic disorders and environmental factors. Bladder calculi occur in approximately 5% of urinary system stones. In addition, giant urinary bladder stones are commonly observed in geriatric patients. This study aimed to compare and evaluate the outcomes of open cystolithotomy, percutaneous and transurethral cystolithotripsy techniques in the surgical treatment of bladder stones in geriatric patients.

Methods: The primary observation metrics comprised stone clearance rate and symptom resolution, and the secondary metrics included complications and recovery time. This study aimed to identify the most suitable technique for this patient group. The medical records of patients who underwent bladder stone surgery between January 2010 and January 2021 were retrospectively reviewed. Geriatric patients aged 65 years and older who had undergone bladder stone surgery were included in this work.

Results: Of the patients, 72 were male, and 4 were female, with a mean age of 72.6 years (range: 65-89). The average stone size was 39.7 × 29.4 mm. Surgical procedures consisted of open suprapubic cystolithotomy in 31 patients, percutaneous cystolithotripsy in 17 patients and transurethral cystolithotripsy in 28 patients. The stone-free rates were 85.7% for the transurethral cystolithotripsy group and 100% for the open cystolithotomy and percutaneous cystolithotripsy groups (p > 0.05). Symptom resolution occurred in 94.7% of cases. No statistically significant differences were observed in the complication rates among the three groups (p > 0.05), with early complications including haematuria (3.9%) and residual stones (2.6%) and late complications comprising fever (1.3%) and urethral stricture (1.3%). The mean hospital stay was 4.3 ± 2.1 days, with no significant differences among groups (p = 0.071). In addition, benign prostatic hyperplasia was present in 84% of male patients, and other conditions included ureteral stones (4 patients), a right-sided hydrocele (1 patient) and a vesicovaginal fistula (1 patient).

Conclusions: All three techniques-open cystolithotomy, percutaneous cystolithotripsy and transurethral cystolithotripsy-can be safely performed in the surgical treatment of bladder stones in geriatric patients. However, large-scale population studies are required to determine the optimal technique.