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

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.