Case Report
An Interesting Case Report of a Giant Bladder Calculi in China
Chen Hui1,2*, Huang Maping1, Huang Tianhai1,Yang Xiaoyi1, Ni JJ1, Li Qingqing1, Liu Qiuling1, Jiang Chonghe2 and Xie Keji3
1Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital and Jinan University, China
2Department of Urology, Qingyan City People's Hospital, China
3Department of Urology, Guangzhou First Municipal People’s Hospital, China
*Corresponding author: Chen Hui, Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital and Jinan University, Qingyan City People's Hospital Guangzhou, China
Published: 05 Nov, 2018
Cite this article as: Hui C, Maping H, Tianhai H,Xiaoyi Y,
Ni JJ, Qingqing L. An Interesting Case
Report of a Giant Bladder Calculi in
China. World J Surg Surgical Res.
2018; 1: 1072.
Abstract
Objective: To reports giant bladder calculi in a 52 year old man.
Methods: The patient was diagnosed as bladder calculi since 1998. Due to the lack of sufficient
medical and health conditions in the country side; he only received the Chinese traditional treatment
and did not seek any urologic treatments for more than 20 years. In April 2018, he was referred to
our hospital with dysuria.
Results: A big bladder calculi (8.0 cm × 10.0 cm × 6.0 cm in size) was revealed by ultrasound and
intravenous pyelography and removed by open cystolithotomy.
Conclusion: Our case demonstrates the necessity of early treatment for patients with bladder calculi.
Keywords: Giant; Bladder calculi; China
Introduction
Bladder calculi is an old and rare disease which accounted for 5% of all urinary calculi [1,2]. Nowadays, based on technical improvements and a growing clinical expertise on minimally invasive treatment, a giant stone in bladder is a very rare condition in china during the past twenty years. In this report, we reported a uncommon case of large bladder calculi.
Case Presentation
In February 2018, a 52-year-old man was admitted tohospital due to a complaint of intermittent,
paiful voiding, terminal hematuria and interruption of the urinary stream. The patient's medical
history revealed that some of these typical worsening discomfort had been observed twenty years
prior to the present study. Due to the lack of sufficient medical and health conditions in the
countryside, he only received the Chinese traditional treatment and did not seek any urologic
treatments for more than 20 years.
Systemic physical examination and rectal examination findings were normal. A complete
urologic examination revealed a palpable solid oval-shaped mass, 8 cm in size, which originated
from suprapubic region of the bladder. Both Color Doppler ultrasound of urinary system and
Intravenous Pyelography (IVP) produced that a large, rounded calcified mass in the pelvis (Figure
1). Undoubtedly, it is difficult for endoscopic techniquesto remove such a giant bladder calculi
completely. Hence, open cystolithotomy was performed (Figure 2). More interestingly, although
the bladder calculi size was relatively huge, it was removed easily and completely without adhesion
to the bladder wall. The extirpated bladder calculi measured 8.0 cm × 10.0 cm × 6.0 cm, and weighed
293.1 gram (Figure 3). The postoperative 3 months follow-up was uneventful and without any
urologic complaint. The calculus was analysed and found to be composed of cystine.
Discussion
It is well recognized that bladder stone usually result from bladder outlet obstruction,
neurogenic voiding dysfunction, or recurrent urinary tractinfection [3]. Bladder calculi are usually
solitary but may develop in multiple stones in the presence of urinary stasis [4]. With the rapid
development of China's economy and health care, bladder stones weighing more than 100 gm are
extremely rare. Undoubtedly, the present case report was more interesting. Firstly, a review of the literature shows that similar studies of giant bladder stone in china
are scanty. Secondary, the extremely large bladder calculi occupied
most of the bladder and pressing on the orifices of the ureters, leading
to the presence of hydronephrosis. Thirdly, the most important point
was that we found no obstructed bladder outlet during the operation.
The reasons we analyzed were that the bladder stone formed after an
upper urinary tract calculi descended into the bladder a long time
ago.
Nowadays, it was wellknown that open approach has been
progressively replaced by newer techniques aimed to be less invasive
[5]. However, irrespective of a large number of alternative surgical
procedures available today, we still choose open cystolithotomy as
treatment choices for this case because it ensured wide vision of the
surgical field to remove such a larger bladder calculi more rapidly
and entirely. Fortunately, the bladder calculi was smooth and not
adherent to the bladder wall which help avoid hematuria, bladder
perforations and mucosal injuries risk.
Bladder calculi is associated with chronic irritation and
inflammation which play a direct role in the development of bladder
cancer [6,7]. In 2008, Farouk K et al. [8] reported a 65-year-old
man with bladder leiomyoma and bladder stone. In 2013, another
study even reported that bladder calculi was found up to 71 (3.4%)
cases in 2,086 patients with bladder cancer between 2001 and 2009
[9]. Fortunately, in this case, the interior of tha patient bladder was
normal and no neoplasm was visible to the naked eyes after the stone
was removed.
Figure 1
Figure 2
Figure 3
Figure 4
Conclusion
This case study reported satisfactory results for a giant stone in 2-year-old male patient. However, bladder stone should be taken into consideration when patients develop lower urinary tract symptoms or other signs occur, such as intermittent, paiful voiding, terminal hematuria recurrent urinary tract infection and interruption of the urinary stream.
Acknowledgment
This study was supported by Medical Scientific Research Foundation of Guangdong Province, China (grant number A2013477, A2018124).
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