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BLAST—bladder lithiasis assessment of surgical treatment in real-world practice. A global prospective multicentre registry by EAU Endourology

Vineet GauharDepartment of Urology, Ng Teng Fong General Hospital, Singapore, SingaporeSteffi Kar Kei YuenDepartment of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China. [email protected]Thomas HerrmannDepartment of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse, Frauenfeld, SwitzerlandJaisukh KalathiaAmelia PietropaoloDepartment of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UKKhi Yung FongDepartment of Urology, Singapore General Hospital, Singapore, SingaporeChawla ArunUrology and Renal Transplant, Kasturba Medical College, MAHE, Manipal, Karnataka, IndiaTianyu LiDepartment of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, ChinaAlexey MartovFederal Medical-Biological AgencyZelimkhan TokhtievFederal Medical-Biological AgencyGiorgio MazzonDepartment of Urology, University College London Hospitals, London, UKAmish MehtaB T Savani Kidney Hospital, Rajkot, IndiaYash PamechaLin XiongDivision of Urology, Shenzhen Hospital of University of Hong Kong, Shenzhen, ChinaAngelo CormioAzienda Ospedaliero-Universitaria delle MarcheEnder Cem BulutDepartment of Urology, School of Medicine, Gazi University, Ankara, TurkeyNariman GadzhievDepartment of Urology, Saint Petersburg State University Hospital, Saint Petersburg, RussiaSohani DassanayakeDepartment of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UKAzizbek ShomarufovDepartment of Urology, Tashkent State Medical University (Republican Specialized Scientific and Practical Medical Center of Urology), Tashkent, UzbekistanLim Tze Ying BenjaminDepartment of Urology, Sengkang General Hospital, Singapore, SingaporeTheodoros TokasEuropean Association of Urology Section of Endourology, Arnhem, The NetherlandsGunal OzgurMarmara UniversityLuca BoeriDepartment of Urology, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy黄云腾Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaYasser Gamil ElnagarDepartment of Urology, Aswan University, Aswan, EgyptZijie ChaiGuangzhou Medical UniversityBohan WangDepartment of Urology, Second Affiliated Hospital of Zhejiang University, Hangzhou, ChinaWilliam Lay Keat OngUrology Unit, Department of Surgery, Hospital Sultanah Bahiyah, Kedah, MalaysiaBenedikt BeckerDepartment of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, GermanyAbdul HaseebInstitute of Kidney Diseases, Hayatabad Medical Complex Peshawar, Peshawar, PakistanLazaros TzelvesEuropean Association of Urology Section of Endourology, Arnhem, The NetherlandsAlba SierraDepartment of Urology, Hospital Clinic-University of Barcelona, Barcelona, SpainThiago HotaHospital Nossa Senhora das Graças, Curitiba, BrazilMallikarjuna ChiruvellaDeepak RagooriNg Chi-FaiDepartment of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, ChinaDaniele CastellaniUrology Unit, Ecclesiastical Entity Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, ItalyBhaskar SomaniDepartment of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

2026en

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Annotatsiya

PURPOSE: This registry aimed to establish a comprehensive global database to characterise contemporary real-world surgical approaches to bladder stones and to describe postoperative stone-free rate (SFR) and complications according to the surgical treatment route. METHODS: The BLAST (Bladder Lithiasis Assessment of Surgical Treatment) registry prospectively enrolled 805 patients across 31 centres in 16 countries between May 2025 and February 2026. Patients underwent transurethral intervention (TI, n = 741), percutaneous suprapubic (PSI, n = 39), or open surgery (OI, n = 25). Postoperative SFR was graded using cross-sectional computer tomography, or ultrasonography, X-ray, or flexible cystoscopy, as Grade A (100% complete clearance), Grade B (single residual fragment), Grade C (multiple residual fragments). Perioperative complications were classified by the Clavien-Dindo criteria. RESULTS: The cohort was predominantly male across all groups. TI patients were older (median 66 vs 60 and 59 years; p = 0.023) and presented with smaller stones (median 2.1 vs 3.0 cm in both other groups; p < 0.001). A history of urinary tract reconstruction was markedly more prevalent in the PSI cohort (23.1% vs 3.5% and 4.0%; p < 0.001). Median hospital stay was significantly shorter following TI (2 vs 3 days; p < 0.001), accompanied by a shorter duration of catheterisation (p < 0.001). Early complications within 48 h were most frequent after OI (48.0% vs 18.6% and 17.9%; p = 0.001), although major complications (Clavien-Dindo ≥ 3) remained rare and comparable across all modalities. No mortality was recorded. Grade A SFR was achieved in 95.5% of TI, 84.6% of PSI, and 100% of OI (p = 0.001). Reintervention for residual fragments was required significantly more often following PSI (10.3% vs 1.3% and 0%; p < 0.001). CONCLUSION: Transurethral cystolithotripsy was the predominant approach in this real-world international cohort and was associated with high stone clearance and shorter postoperative recovery. Percutaneous and open approaches were selectively used in patients with larger stone burdens, complex anatomy, prior urinary tract reconstruction, or specific urethral limitations. These findings describe contemporary treatment patterns and observed outcomes rather than comparative treatment effectiveness.

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DOI: 10.1007/s00345-026-06813-3

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