傳統剖腹膀胱切開術取出超過40顆完整像鵝卵石的膀胱結石：一個病例分析
黃韋鈞、陳汶吉

中國醫藥大學附設醫院 泌尿部

More than 40 Cobblestone Bladder Stones Retrieval via Open Cystolithotomy: A Case Report

Wei-Chun Huang, Wen-Chi Chen

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction:

Bladder stones, although less common in modern practice, can still present as a significant clinical issue, particularly in patients with predisposing factors such as urinary retention, neurogenic bladder, or bladder diverticula. Open cystolithotomy, a traditional surgical technique, remains an effective method for the removal of large or multiple bladder stone. Here, we present a case of a patient with multiple cobblestone bladder stones successfully managed by open cystolithotomy.

Case:

An 82-year-old man with the past history of benign prostatic hyperplasia (BPH) under medication, was admitted to our ward due to a one-year history of frequent urination.

Tracing back to his history, the patient experienced hematuria for several months six years ago, at which time a right inguinal hernia and two vesical stones were diagnosed. He underwent right inguinal hernioplasty and cystolithotripsy at the same time in 2017.

This time, in the current presentation, the patient reported frequent urination and weak urinary stream over the past one year. However, he denied fever, abdominal pain, flank pain, pelvic pain, dysuria, or gross hematuria. The patient went to local medical doctor (LMD), where bladder sonography revealed multiple stones in the bladder, and he was further referred to our urology clinic. At our clinic, laboratory results showed elevated PSA (17.33 ng/mL), fair kidney function (BUN/Cr: 32/0.88). Urine routine analysis revealed microhematuria. Pelvic ultrasound showed hyperechoic densities with acoustic shadowing, consistent with the presence of vesical stones. He was then received open cystolithotomy on 2023/12/27. Total operation time was 142 minutes. More than 40 bladder stones in the bladder were removed by open cystolithotomy. We close the bladder two layers by continuous  4-0 Vicryl rapid for mucosa, 3-0 vicryl for seromuscular layer in interrupted fashion. Toomey 200ml was test and showed no leakage. He recovered well and we removed JP drain on the POD-6. Follow up KUB showed stone free.

Conclusion:

 Open cystolithotomy remains an effective and reliable surgical option for the removal of large or multiple bladder stones. While less commonly performed today due to the improvement of minimally invasive techniques, open cystolithotomy is still essential for managing complex or recurrent bladder stones, especially in patients with comorbidities or anatomical factors that may complicate other methods. In this case, the patient with a history of bladder stones and frequent urination benefited from this procedure, which was performed with a smooth postoperative recovery and had complete stone free rate.