Acharya Ganesh Bhakta, Baral Suman, Bijukchhe Sunil Man, Mishra Sushil, Bhusal Krishna, Poudel Shasi
Department of Urology, Manipal College of Medical Sciences, Pokhara, Nepal.
Department of Surgery, Mediplus Hospital and Trauma Center, Pokhara, Nepal.
Int J Surg Case Rep. 2024 Sep;122:110174. doi: 10.1016/j.ijscr.2024.110174. Epub 2024 Aug 14.
Giant urinary bladder stones are rare phenomenon which is associated with chronic urinary infections, intravesical foreign bodies, urethral strictures, bladder diverticula etc. CASE REPORT: A 52-year-old man presented with complaints of severe dysuria, urgency, frequency, suprapubic pain, and pollakuria for the last ten years. Physical examination revealed a palpable suprapubic mass with no obvious flank masses. Ultrasonography of the abdomen and pelvis revealed right-sided gross hydroureteronephrosis and thinning of renal parenchyma along with a hyperechoic structure with posterior acoustic shadowing was noted in the region of the urinary bladder, suggesting a vesical calculus. Plain CT of the kidneys, ureters, and bladder (KUB) confirmed right nephrolithiasis in lower poly calyx and a large vesical calculus (10.6 cm × 8.6 cm x8.8 cm, +1110 HU). Open cystolithotomy with a right-sided double-J "DJ" stent insertion was performed. Post-operative period went uneventful.
Giant bladder stones are extremely rare, often resulting from neglected symptoms in otherwise normal individuals. They typically develop over several years and present with symptoms like severe dysuria, urgency, frequency, supra-pubic pain, and hematuria. Diagnosis is made by cystoscopy, ultrasonography and CT-KUB. Treatment includes intracorporeal cystolithotripsy using a laser, ultrasonic lithotripter, or pneumatic lithotripter, depending on availability. Endourologic procedures have been safer and more cost-effective for bladder stones, however, open removal is the treatment of choice for giant bladder stones.
Open cystolithotomy can be performed to remove giant bladder stone with near 100 % stone removal rate.
巨大膀胱结石是一种罕见现象，与慢性泌尿系统感染、膀胱内异物、尿道狭窄、膀胱憩室等有关。病例报告：一名52岁男性，在过去十年中出现严重排尿困难、尿急、尿频、耻骨上疼痛和夜尿增多等症状。体格检查发现耻骨上可触及肿块，未发现明显的侧腹肿块。腹部和盆腔超声检查显示右侧严重肾盂输尿管积水和肾实质变薄，同时在膀胱区域发现一个伴有后方声影的高回声结构，提示膀胱结石。肾脏、输尿管和膀胱的平扫CT（KUB）证实右肾下极多个肾盏结石以及一个大的膀胱结石（10.6 cm×8.6 cm×8.8 cm，+1110 HU）。实施了开放性膀胱切开取石术并插入右侧双J“DJ”支架。术后恢复顺利。
巨大膀胱结石极为罕见，通常源于原本正常个体对症状的忽视。它们通常在数年内形成，表现为严重排尿困难、尿急、尿频、耻骨上疼痛和血尿等症状。通过膀胱镜检查、超声检查和CT-KUB进行诊断。治疗方法包括根据设备情况使用激光、超声碎石机或气压弹道碎石机进行体内膀胱碎石术。然而，对于膀胱结石，腔内泌尿外科手术更安全且更具成本效益，但开放性取出是巨大膀胱结石的首选治疗方法。
开放性膀胱切开取石术可用于取出巨大膀胱结石，结石清除率接近100%。
