馬來西亞 亞羅士打 仁愛專科醫藥中心 泌尿外科

Division of Urology, Putra Medical Centre, Alor Setar, Malaysia

 

Purpose: This study is to introduce the presently clinical practice in management of huge bladder stone cases in northern Malaysia urology department.  

Materials and Methods: Total 6 cases of bladder stones were enrolled in this study during April 2012 to December 2016. Presenting S/S including: acute urinary retention, hematuria, dysuria, etc. Average age of patients was 71.16 years old (55 years old to 83 years old). Male to female ratio were 5: 1. Mostly Renal Ultrasound and CT scan without enhancement and KUB were used for diagnosis. Concerning lab tests and urine tests were done. All patient received open cystolithotomy stone extraction with one case received ureteroscopic stone extraction with JJ stenting (Fr 6 X 26cm JJ stent) concomitantly. Four patients under spinal anesthesia whereas other two received general anesthesia. 

Results: The imaging study shown huge bladder stone from size 2 cm to 5 cm whereas one patient noted of 6 multiple bladder stones (range 1 to 1.5 cm separately). Medical history include: CVA in 2 cases, Hypertension in 2 cases, Diabetic in 1 case. Lab data revealed renal insufficiency in 4 cases (Cr: 174; 133; 156; 397), hyperuricemia in 3 cases ( Uric acid: 500: 415; 571; 671) , anemia (Hb: 10.4) in 1 case, hyperlipidemia in 3 cases, Hyponatremia in 1 case (Na:132), thrombocytopnuia in 2 cases (plt: 81 and received transfusion before surgery; plt 131). Urine test revealed hematuria with infection in all cases. (One had urosepsis with E.coli infection). A 64 year old male with 2 cm bladder stone with bladder clots was noted of severe bulbomembranous urethral stricture via cystoscopy thus shift to open cystolithotomy and cystostomy with Fr 16 silicone foley. Another 80 year old male with 4 cm bladder stone had received cystolithotomy and Right URSM with JJ stent for his right low ureter stone (1 cm) concomitantly. The JJ stent was removed after 1 month. Average hospitalization was 5.6 days with one 80 year old male need intensive care post operation. Average operation time was 66 min with minimal complication. Foley was removed within 7 to 17 days whereas the cystostomy tube was remained. A 74 year old man whom developed urosepsis was foley dependant. Stiches was removed within 12 to 17 days.

Conclusion:  Bladder stones are commonly associated with bladder outlet obstruction, chronic infection or foreign body retained and others. The affected rate is about 5% in Western population. The composition of calculi are formed of calcium in 70%, uric acid in 20%, struvite in 10% and cysteine less than 1 %.¹ Various of treatment modality including: extracorporeal shock wave lithotripsy (ESWL), transurethral cystolithotripsy, percutaneous shock wave lithotripsy and open surgery. Different rates of calculus free are reported, as follows: ESWL (75-100%), transurethral cystolithotripsy (63-100%), percutaneous method (89-100%) and open surgery (100%).¹

Fabio Cesar Miranda Torricelli, Eduardo Mazzucchi,.et al. Surgical management of bladder stones: literature review. Rev. Col.Bras.Cir.vol.40 no.3 Rio de Janeiro May/June 2013