林宗彥、陳奕宏、鄭裕生、林永明

國立成功大學附設醫院斗六分院泌尿科、國立成功大學附設醫院泌尿科

Tsung-Yen Lin^a、I-Hung Cheng^a、Yu-Sheng Cheng^a、Yung-Ming Lin^b

^aDivision of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, ^bDepartment of Urology, Medical College and Hospital, National Cheng-Kung University, Tainan, Taiwan

 

To describe a case of giant bladder stone in healthy young male

A 36-year-old male had no underlying systemic disease before. He worked at cleaning squardron and was living with his mother. He had intermittent perineum pain, difficult urination, and incontinence for many years but he only took some medicine for pain control by himself. He was brought to our ER due to general malaise, weakness and severe perineum pain. Lab revealed acute renal failure (Crea=6.96), hyperkalemia (K=5.8), hyponatremia (Na=113), and leukocytosis (WBC=26500) initially. Abdominal CT revealed giant bladder stones with bilateral hydroureter and hydronephrosis. Bilateral PCN insertion was performed separately and much pus was drained out from right PCN. Bilateral antegrade pyelography was performed 6 weeks after PCN insertion and it showed persisted dilated bilateral pelvis and ureter. Cystoscopy, cystolithotomy, and suprapubic cystostomy were performed thereafter. The size of the stone was 11cm in length, 7.5cm in width, and 7cm in height, just like an adult’s fist. Its weight was 520gm. Suprapubic cystostomy tube was removed smoothly after bladder training.      

The composition of this giant bladder stone was 100% calcium phosphate. The post-operative renal function recovered gradually and serum creatinine kept below 2 in followed one year. He could urinate by himself and denied any discomfort of urination.  He was back to work three months after operation.   

Most giant bladder stones were found in patients with underlying disease resulted in voiding problem or unclear conscious. It’s a rare giant bladder stone in health young male.