900 Grams Giant Bladder

Stones with Minimal Symptoms.

A Case Report
Buyung Prasetyawan1, Dodo Wikanto2
1
General Practitioner, Medical Faculty of Brawijaya University, Malang East Java, Indonesia
2
Department of Urology Medicine, Kediri General Hospital, Kediri East Java, Indonesia

Background & Aim

Urolithiasis is quite common in Indonesia. In 2002, the ministry found 3.763 cases. Urolothiasis can be found
in many locations such as kidney, ureter, urethra and vesica urinaria. The prevalence vesicolithiasis is about
4-20% cases. Commonly, vesicolithiasis has many symptoms, and rarely weight more than 100 grams. Here
we are presenting a case of multiple giant stones with total weighing 900 grams and minimal symptoms. [3,5]

Methods
A-42-years-old male, a farmer came to hospital complaints 10 days with
dysuria. The pastient also complained nocturia, more than 7 times. The
patient had no experience hematuria, fever, rheumatoid, urolitiasis, or
urinary tract infection. Physical examination had palpable a solid mass in
umbillical region.
Laboratory
haemoglobin 9,3 gm/dl, haematocrit 27,1 %, natrium
123 mg/dl.
Profilaxis Cefazolin was administered and Sub Arachnoid Block was
performed using lidocaine. Open surgery vesicolithotomy was perfomed.
The abdomen was opened using pfannenstiel incision to remove multiple
vesicolithiasis, the first stone was 9x7x6 cm, and the second stone 11x9x9
cm. Urethral lithiasis 1x0.5x0.5 cm was removed by posterior lubrication.
Total stones weight was 900 grams. During surgery, drainage and
catheterization was performed.

Abdominal-pelvic ultrasonography (USG)

multiple vesicolithiasis 7 x 10 cm in diameter, cystitis
and hydroureteronefrosis sinistra.

Abdominal X-ray
multiple vesicolithiasis 9 cm, and 10 cm in diameter.
Urethral lithiasis 1 x 2cm.

Multiple Giant Stones And

Uretral Lithiasis

Total Multiple Giant

Stones Weight

After surgery, stones examination has been perfomed and patient was
monitor until 5 days in hospital and treated with amoxicillin 3x500mg,
mefenamate acid 3x500mg, and ciprofloxacin 2x500mg. Afterwards, the
drainage was removed and patient discharged. On the monitoring The
Abdominal X-ray Abdominal-pelvic Ultrasonography patient got better without further urinary complaints and can life normally.

Result
Giant bladder stones are directly proportional to the socio-economic. Furthermore, there are also several other risks factor such as age, climate, high purine or
oxalate foods, water contents consumed, climate, occupation, family history, objects foreign, or infection.[1,2] In this case patient has several risk factors, sex(male),
low socio-economic, and occupation. Giant bladder stone occurs more frequently in males as compared to females, which is caused by the differences in the
anatomical structure. Males have longer urinary tract than female, which facilitates stone formation. Furthermore, males have higher testosterone level which
allows easier calcium buildup, whereas females have higher estrogen level which prevents calcium salt formation. Low socio-economic contributes to lesser
knowledge of health, hygiene and lack of water. Occupational factor, such as working in a farm, exposes them to high tempatures which impact hydration levels
and improve risk of developing bladder stones. [4,5]
Bladder stones have caused such complaints hematuria, painful micturition, recurrent UTI, suprapubic pain,
urinary retention, and nocturia. Mostly patient complaint in years, but in this case patient complains about dysuria and nocturia 10 days. This might be caused by
the patientʼs lack of awareness regarding micturition problems. Furthermore, as a farmer with low socio-economic condition restricts them from visiting doctors.
[2,4]
Bladder stones contains of calcium oxalate, calcium phosphate, and calcium carbonate. There is study about bladder stones, and over 52% contained calcium
oxalate, 45,9% phosphate, 26% ammonium , and 25% struvite. In this case, stones examination has been perfomed and got a result calcium oxalate
monohydrate(whewellite) 53%, carbonate apatite phosphate(dahllite) 37%, and matrix(unknown contain,usually protein) 10%. Bladder stones are usually
founded with renal or ureteral stones, but in this case unique there is stones in urethral. Therapy for vesicolithiasis can be done such as extracorporeal shock waver
lithotripsy(ESWL), percutaneous cystolithotomy, transuretrhal cystolithopexy or open surgery (vesicolithotomy). In this case the treatment using open
vesicolithotomy because multiple stones and also the size of the stone that is too large. [1]

Conclusion
Giant bladder stones with minimal symptoms are rarely case in urology
case. Not all giant bladder stones patient have many symptoms. Giant
bladder stones are directly related with socio-economic factor, low
socio-economic condition is linked with higher morbidity. Most giant
bladder stones content are calcium oxalate. Open vesicolithotomy can be
done to eliminate multiple stones and also the large stones.
Key Words
Giant bladder stones, Minimal Symptoms, Vesicolithotomy
References
1. Basuki, P. Dasar – dasar urologi edisi ketiga. 2014. CV. Sagung Seto
2. Charles,A . Giant urinanry bladder stone. 2018.edorium jorunals
3. İbrahim T. Giant bladder stone: A case report and review of the literature.
Turkish Journal of Urology 2014; 40(3): 189-9
4. Rohit, A. Giant bladder stone in association with severe kidney injury.
Oxford Medical Case Reports, 2019;7, 324–326
5. Suryanto, F. Agung, A. Gambaran Hasil Analis Batu Saluran Kemih Di
Laboratorium Patologi Klinis RSUP Sanglah Denpasar Periode November
2013 – Oktober 2014. Fakultas Kedokteran Universitas Udayana . 2017