Suprapubic Drainage During Transurethral Cystolithotripsy for Large Bladder Stones

Inclusion Criteria: * Age 18 years or older. * Radiologically confirmed bladder stone with maximum diameter greater than 2 cm. * Scheduled for elective transurethral cystolithotripsy. * Sterile urine culture before surgery, or adequately treated urinary tract infection according to culture sensitivity. * Fit for spinal or general anesthesia. * Ability to provide written informed consent. Exclusion Criteria: * Urethral stricture preventing safe cystoscopic access. * Active uncontrolled urinary tract infection or sepsis. * Neurogenic bladder with severely impaired bladder emptying requiring chronic catheterization. * History of bladder cancer or suspected bladder tumor requiring simultaneous transurethral resection of bladder tumor. * Coagulopathy or uncorrected bleeding tendency. * Patients requiring concomitant transurethral resection of the prostate, Holmium laser enucleation of the prostate, or other prostate surgery in the same session. * Previous pelvic radiotherapy or major lower urinary tract reconstruction. * Pregnancy. * Refusal to participate.