Aji Iwan Purnomo, Renaldo Johan, Andhika Dimas Panca
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2025 Mar;128:110933. doi: 10.1016/j.ijscr.2025.110933. Epub 2025 Feb 4.
A giant bladder stone is a rare urological condition in which a massive stone forms due to various contributing factors. We present a rare case of a giant bladder stone with concurrent ureteral stones, detailing its staged surgical management and relevant literature.
A 44-year-old male presented with right flank, left flank, and suprapubic pain for one month prior to admission, accompanied by dysuria and a history of stones passage through the urinary tract. On examination, the patient presented with suprapubic pain, and laboratory results revealed severe anemia with elevated blood urea nitrogen (BUN) and serum creatinine levels. A vesicolithotomy was performed, followed by ureteroscopic lithotripsy (URS) one month later. A 15 × 10 cm bladder stone was found during the first surgery, and multiple ureteral stones were discovered during the second surgery. After surgery, the patient improved BUN (93.5 mg/dL to 27.6 mg/dL), serum creatinine (8.11 mg/dL to 1.85 mg/dL), and reduced flank and suprapubic pain.
The management of giant bladder stones involves open vesicolithotomy, which is considered the gold standard for complete removal, as AUA and EAU guidelines recommend. A subsequent URS for the removal of bilateral ureteral stones provides a favorable outcome for the patient.
A holistic approach for giant bladder stones is required, encompassing diagnosis and surgical planning to minimize misdiagnosis and complications. A staged surgical approach, including vesicolithotomy and ureteroscopic lithotripsy, may be beneficial.
巨大膀胱结石是一种罕见的泌尿系统疾病，由多种因素导致形成巨大结石。我们报告一例罕见的巨大膀胱结石合并输尿管结石病例，详细阐述其分期手术治疗及相关文献。
一名44岁男性在入院前一个月出现右腰、左腰及耻骨上区疼痛，伴有排尿困难及有结石排出尿路的病史。检查时，患者有耻骨上区疼痛，实验室检查结果显示严重贫血，血尿素氮（BUN）和血清肌酐水平升高。先行膀胱结石切除术，一个月后进行输尿管镜碎石术（URS）。首次手术发现一枚15×10cm的膀胱结石，第二次手术发现多发输尿管结石。术后，患者的BUN（从93.5mg/dL降至27.6mg/dL）、血清肌酐（从8.11mg/dL降至1.85mg/dL）有所改善，腰腹部及耻骨上区疼痛减轻。
巨大膀胱结石的治疗包括开放性膀胱结石切除术，这被认为是完全清除结石的金标准，正如美国泌尿外科学会（AUA）和欧洲泌尿外科学会（EAU）指南所推荐的。随后进行URS以清除双侧输尿管结石，为患者带来了良好的治疗效果。
对于巨大膀胱结石需要采取整体治疗方法，包括诊断和手术规划，以尽量减少误诊和并发症。分期手术方法，包括膀胱结石切除术和输尿管镜碎石术，可能是有益的。
