الفهرس 
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Abstract
Bladder stones are the most common manifestation of lower urinary tract lithiasis, currently accounting for 5% of all urinary stone disease and approximately 1.5% of urologic hospital admissions in industrialized Western nations.(1)
The most common presenting symptom of bladder calculi is macroscopic hematuria, which generally is terminal.(2)
Intermittency, frequency, urgency, dysuria, decreased force of the urinary stream, incontinence, and lower abdominal pain aggravated by brisk movement may also be present. (3)
Once the gold standard for bladder stone treatment, the open approach has fallen into disfavor as newer, less invasive techniques have come to the fore. Open cystolithotomy, while successful, is associated with the need for prolonged catheterization,increased length of hospital stay, and poor cosmesis from therequired incision.(4)
Percutaneous techniques have recently been championed, especially in patients without serviceable urethral access, such as patients who have undergone prior bladder neck reconstruction or closure. This method generally involves the creation and dilatation of a suprapubic tract after the bladder is distended. An Amplatz sheath is used in the vast majority of reported techniques although concern over inadvertent loss of access has compelled some to use a Hasson trocar instead. (5)
A combination of ultrasonic and pneumatic energy is used to fragment the stone;small fragments may be suctioned while larger fragments are removed using stone forceps. Suprapubic or transurethral catheter drainage is required for 1 to 5 days.(4,5 Average operative times for percutaneous cystolithotomy range from 20 to 86 minutes. (4,5),with successful eradication of stone in 89% to 100% of patients after a single procedure. Complications, including urine leak and persistent hematuria, are rare occurring in approximately 1% of patients. (4) For patients requiring surgical management for BPH , TURP can be safely performed after percutaneous cystolithotomy.(5 The transurethral approach for bladder stone treatment is attractive because it allows for the use of a natural orifice for access. A lithotrite may be used but has fallen into disfavor owing to the high incidence of mucosal injury and bladder perforation as well as the inability to address large calculi and a high rate of stone recurrence.