A rare case of a 2-pound urinary bladder stone in a 32-year-Old male

Abstract

Giant bladder stones over 500 g are extremely rare. This case report describes a 2-pound bladder stone, emphasizing its clinical presentation, diagnostic challenges and surgical management.

We present a case of a 32-year-old male with progressive urinary retention, hematuria, and dysuria. Imaging revealed a 2-pound bladder calculus, managed successfully via open suprapubic cystolithotomy. The patient's symptoms resolved completely, and recovery was uneventful.

This case highlights the need for early diagnosis and timely surgical management to prevent complications such as obstruction and renal damage. Preventive measures, including adequate hydration and nutrition, remain vital, especially in resource-limited settings.

1. Introduction

Bladder stones, or vesical calculi, are hard mineral deposits that form within the urinary bladder. While more prevalent in developing countries, their occurrence is associated with poor access to clean drinking water and inadequate nutrition1, 2. These stones can be composed of oxalate, uric acid, cystine, or triple phosphate, and they vary in size from small, asymptomatic stones to large, symptomatic masses that require surgical removal³.

Bladder stones are categorized based on their composition and size. Small stones (less than 0.5 cm) are typically asymptomatic, while moderate stones (0.5–1.5 cm) may require intervention, and large stones (greater than 1.5 cm) often necessitate surgical treatment. Symptoms in patients with bladder stones include urinary frequency, hematuria, pain at the end of urination, and acute urinary retention³. Large stones can exacerbate these symptoms, leading to significant morbidity.

Management strategies include ultrasound lithotripsy for smaller stones, laser lithotripsy for larger stones, percutaneous suprapubic litholapaxy, and open cystolithotomy for very large stones⁴. While large bladder stones are rare, they can cause significant complications if untreated, including obstructed bladder outlets and potential renal damage⁵.

2. Case presentation

A 32-year-old male presented with a one-month history of dribbling urine, followed by acute urinary retention over the past three days. He also reported hematuria and dysuria. The patient had a history of intermittent lower abdominal pain, which he managed with marijuana for temporary relief. He came from a low socioeconomic background with limited access to clean drinking water and adequate nutrition, both of which may have contributed to the formation of the bladder stone2, 6.

On physical examination, the patient appeared emaciated, and a firm, non-tender mass was palpable in the hypogastric region. Percussion revealed dullness, suggestive of a large bladder stone. Imaging studies, including a plain radiograph of the kidneys, ureters, and bladder (KUB) and abdominal ultrasound, confirmed the presence of a large, globular stone in the pelvis(as shown in Fig. 1). Routine blood tests showed borderline serum urea and creatinine levels. After thorough counseling, the patient consented to surgery for stone removal.

Fig. 1.

Pre-operative X-ray showing large bladder stone occupying the pelvis.

The patient underwent suprapubic cystolithotomy, a procedure involving a midline incision above the pubic symphysis. Upon opening the bladder, a large, brown, hard stone occupying the entire bladder was identified. The stone was fragmented with a hammer and chisel, and all fragments were carefully removed(as shown in Fig. 2, Fig. 3). The bladder was sutured with PDS 1-0, and a suprapubic catheter was placed. The abdominal layers were closed with No. 1 PDS, and the skin incision was closed with Nylon 2-0. A transurethral Foley catheter was inserted.

Fig. 2.

Post-operative image of giant bladder stone after removal.

Fig. 3.

Post-operative image of giant bladder stone after removal, showing the various stone fragments.

Suprapubic cystolithotomy is a well-established technique for removing large bladder stones, especially when they cannot be fragmented effectively using less invasive approaches such as laser lithotripsy4, 7.

The postoperative course was uneventful. The patient began passing urine normally, and serum urea and creatinine levels returned to baseline. The urethral catheter was removed on the fourth postoperative day, and the patient was discharged on the sixth day with a suprapubic catheter. The catheter was removed during a follow-up visit five days later. A urethral catheter was inserted for an additional five days to ensure proper healing of the suprapubic cystostomy site. This standard postoperative care is crucial for preventing complications such as wound infection or bladder leakage and has been shown to result in favorable outcomes in similar cases⁸.

3. Discussion

While urolithiasis is common, large bladder stones—such as the 2-pound stone in this case—are exceedingly rare⁵. This case illustrates the significant clinical challenges posed by such stones, including obstructed bladder outlets and the risk of renal failure if left untreated. Factors such as chronic marijuana use, poor nutrition, and limited access to clean water likely contributed to the formation of the stone by promoting dehydration, recurrent urinary tract infections, and urine supersaturation with crystallizing substances, which increase the risk of stone formation2, 6.

Surgical intervention is required for the management of large bladder stones, with suprapubic cystolithotomy being the most appropriate approach in this case due to the stone's size. While laser lithotripsy and percutaneous litholapaxy are suitable for smaller stones, open cystolithotomy remains the gold standard for large stones4, 7. Public health initiatives focused on improving hydration, nutrition, and access to healthcare are essential for preventing bladder stone formation, particularly in resource-limited settings. Early medical intervention is critical in preventing complications, such as renal damage⁹.

4. Conclusion

This rare case of a 2-pound bladder stone underscores the importance of early diagnosis and intervention to prevent severe complications such as renal failure. Timely surgical treatment can significantly improve a patient's quality of life. Recognizing the symptoms of large bladder stones and understanding their potential severity is crucial for clinicians to provide optimal care and ensure favorable patient outcomes.

CRediT authorship contribution statement

Aalamnoor Singh Pannu: Writing – original draft. Barinder Singh Pannu: Writing – review & editing.

Ethical approval

Not applicable.

Patient consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Funding

No funding was received for this work.

Conflicts of interest

None declared.