STONE CLEARANCE RATE OF TRANSURETHRAL NEPHROSCOPIC PNEUMATIC LITHOTRIPSY FOR THE MANAGEMENT OF LARGE URINARY BLADDER CALCULI USING THE PNEUMATIC SWISS LITHOCLAST

Abstract

Background: large urinary bladder calculi can require effective endoscopic fragmentation while avoiding the morbidity of open surgery. transurethral nephroscopic pneumatic lithotripsy using the swiss lithoclast is a minimally invasive technique described for this purpose. this study assessed stone clearance and perioperative outcomes in patients treated at a tertiary urology unit. Materials and Methods: A descriptive study was performed at Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar on 86 patients aged 18–65 years with large urinary bladder calculi (>2.5 cm) treated by transurethral nephroscopic pneumatic lithotripsy. Consecutive non-probability sampling was used. Stone clearance was defined as complete absence of stone on postoperative CT at 14 days. Demographic, stone, operative, hospital stay, and complication data were analyzed using descriptive statistics. Stratified comparisons used chi-square or Fisher's exact test, with p<0.05 considered significant. Results: Mean age was 50.56±8.29 years, mean BMI 28.30±2.76 kg/m², and mean stone size 37.66±8.14 mm. Complete stone clearance was achieved in 83/86 patients (96.5%; 95% CI 90.2–98.8%). Clearance was 100% for single stones and 86.4% for multiple stones (Fisher's exact p=0.015). Intraoperative complications occurred in 7 (8.1%) and postoperative complications in 15 (17.4%). Non-clearance was observed in three patients, all with multiple stones, and these patients had larger stones, longer lithotripsy time, and longer hospital stay. Conclusion: Transurethral nephroscopic pneumatic lithotripsy using the Swiss Lithoclast achieved a high stone clearance rate of 96.5% in this dataset, with acceptable reported perioperative complications. Multiple-stone disease was associated with the observed failures and may identify patients requiring particular procedural planning.