Giant bladder stone with history of recurrence urinary tract
A 32-year-old male came to urology clinic with history of lower abdominal pain and dysuria. These symptoms had been felt for the past 2 years and progressive. Patient frequently complaint urinary urgency, pollakiuria, incomplete emptying and sometimes hematuria. No history of any injury. Patient had received some antibiotics and painkillers for recurrence UTI for the past 1 year.

On physical examination, vital signs were normal and abdomen was soft. Digital rectal examination revealed normal prostate. Likewise, blood counts, kidney and liver function were in normal limit. The results of urinalysis showed that pH 5.2, in urine sediments there were 10 cells erythrocytes per field of view and presence of calcium oxalate crystals. Leucocyte and nitrite were negative on urinalysis. Plain abdominal radiograph revealed round calcified pelvic calculi measuring 12.4 × 7.8 cm. Abdominal ultrasound confirmed the presence of pelvic calculi and there was no hydronephrosis.

Patient received intravenous ciprofloxacin and underwent open cystolithotomy with general anesthesia for calculi removal. Although the bladder calculi size was relatively large, it was removed easily and completely without adhesion to the bladder wall. The extirpated calculi measured 12.6 x 9.8 × 7.5 cm, 832 g. Both cystotomy catheter and urethral folley catheter was inserted. The result of the stone analysis was calcium oxalate.

Patient was discharged on day 6 and did not show any sign of complications. Post-operative wound remained well, no significant infection or inflammation was observed. During follow-up, patient remained symptom-free and has experienced no further stone formation.

Source: Urology case reports

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