The authors present a 68 year-old man, with history of benign prostatic hyperplasia, who came to the emergency department after clinical evaluation by an internal medicine physician who diagnosed acute renal lesion (urea 266 mg/dL and creatinine 8,87 mg/dL) in laboratory evaluation. Physical examination didn’t show significant changes. To study this acute renal lesion, the patient was submitted to a bladder and renal ecography that showed bilateral ureterohydronephrosis and two large bladder calculus with dimensions of 72x44mm and 56x30mm (figure 1). He as also submitted to an abdominal and pelvic CT-scan which confirmed previous findings (figure 2). These bladder calculi were removed through open cystostomy, with partial recovery of renal function. However, as sequela, the patient developed chronic nephropathy.
Bladder calculi account for 5% of urinary calculi, are more likely in males and is associated to bladder outlet obstruction, urinary tract infection or foreign bodies. It is likely that a patient with a giant bladder calculus will present with urinary tract infection, hematuria or urinary retention,
1,2. Extremely large bladder calculi may pressed on the orifices of the ureters, leading to the presence of hydronephrosis,
1. Cystoscopy is the preferred method of diagnosis, but an X-ray or an ultrasound is sometimes enough,
2. Surgical intervention is the preferred treatment,
1,2.
Figura I
Bladder and renal ecography showing two large bladder calculus
Figura II
Pelvis and abdomen CT-scan: sagital view of a large bladder calculi and coronal view of two large bladder calculus with dimensions of 72x44mm and 56x30mm
BIBLIOGRAFIA
1 Giant bladder stone in a male patient: A case reportChengquan Ma, Bingxin Lu, ErLin Sun Medicine (Baltimore) 2016 Jul; 95(30): e4323. Published online 2016 Jul 29. doi: 10.1097/MD.0000000000004323 PMCID: PMC5265848
2 Giant bladder stone: A case report and review of the literatureİbrahim Nüvit Tahtalı, Turgay Karataş Turk J Urol. 2014 Sep; 40(3): 189–191. doi: 10.5152/tud.2014.02603 PMCID: PMC4548388
