A case of vesical megalithiasis
Published in the journal Urology Case Reports, the authors present a unique case of a female who presented with a large bladder stone and ultimately required a cystolithotomy.

A 57-year-old female with a two-year history of recurrent UTIs presented with bilateral flank and suprapubic pain. Past medical history consisted of recurrent UTIs for many years, treated intermittently with antibiotics. No further workup of these UTIs was conducted. She denied any history of hematuria or unintended weight loss.

She did endorse “difficulty urinating” since she was about 9 years old. Physical exam revealed mild bilateral costovertebral tenderness and a hard, rock-like mass was palpated in the lower abdomen. Urethral catheterization was attempted but was unsuccessful.

Labs were notable for a mild leukocytosis of 10.5 with left shift, and blood urea nitrogen and serum creatinine of 105 and 6.0, respectively. Urinalysis showed 929 WBCs and 626 RBCs and gram stain showed gram negative bacilli. A non-contrast CT demonstrated a large bladder calculus, measuring 11 cm × 8.4 cm with a value of 794 Hounsfield Unit. The stone filled the entire urinary bladder with severe upstream hydroureteronephrosis.

Key takeaway:-
- It is important for clinicians to consider bladder stone in patients with signs of recurrent lower urinary tract symptoms, pyuria, or hematuria.

- Basic metabolic panel is warranted in these patients to assess renal function for appropriate management.

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