Obstructive uropathy from a giant urinary bladder stone: a rare urological emergency

Abstract

A 53-year-old man presented with lower urinary tract symptoms and recurrent urinary tract infections since last 3 years without being investigated or treated properly. Examination revealed a hard mobile lump in the pelvis, and blood investigations showed raised serum creatinine of 2.9 mg/dL. Subsequent urgent ultrasound scan showed a large urinary bladder stone with bilateral hydroureteronephrosis, and X-ray kidney, ureter and bladder demonstrated a 9 cm×6 cm elliptical radio-opaque shadow in the pelvis. He underwent emergency admission followed by open cystolithotomy on the next day. He was discharged after 48 hours with a urethral catheter. After 2 weeks, his renal function recovered completely; repeat ultrasound scan revealed complete resolution of hydronephrosis. Urethral catheter was removed following a normal cystogram. Uroflowmetry after 6 weeks revealed underlying bladder outlet obstruction, and he was started on alpha blocker which improved his urinary flow.

Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report

“…Open surgery offers the advantage of shorter operative time, particularly when dealing with multiple giant stones. In all documented cases where large bladder stones measuring 6.5 cm or more were associated with renal impairment, open cystolithotomy was the chosen treatment method [7]. In our case, we also decided to employ the same approach for stone removal due to the elevated density of both the prostatic and bladder stones, in addition to the aforementioned reasons.…”

“…It is advisable to involve renal physicians in such cases for their input and expertise. The recovery of renal function following stone removal is contingent upon the degree of renal damage [7]. Previous literature by various authors reporting cases of giant bladder stones accompanied by renal failure consistently indicated an improvement in renal function after cystolithotomy.…”

Vesicocutaneous fistula at site of closed suprapubic tube tract as the first presenting sign of giant bladder stone

“…This represents a rare case in which the mounting intravesical pressure from outlet obstruction alone cannulated the prior suprapubic tube tract and resulted in a vesicocutaneous fistula. Hydronephrosis, although rare, is seemingly more common in patients with giant bladder stones with several cases describing such a presentation 6–8…”