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      Giant Bladder Calculus in an Adult- A Persistent Problem in the Developing World: A Case Report

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          Abstract

          Introduction

          Giant urinary bladder calculus in an adult is an uncommon entity. The number of patients with giant bladder calculi has decreased over recent years owing to wider availability of healthcare and better diagnostic modalities.

          Case Report

          We present a case of a young adult without any history of recurrent urinary tract infections or bladder outlet obstruction with giant vesical calculus who presented to the emergency department with gross hematuria, abdominal pain, and dysuria. Investigations revealed a large calculus in the urinary bladder, and suprapubic cystolithotomy was performed. A large stone of 6.5×6×5.5 centimeters, weighing 125 grams, was removed. On follow-up, the patient was free of any symptoms and cystoscopy was normal.

          Conclusion

          Urinary outflow obstruction must be ruled out in all patients with giant vesical calculus. Patients without any predisposing condition should be treated as a separate entity and evaluated accordingly. Multiple surgical treatment modalities are available for bladder calculus patients. Treatment is personalised as per size of stone, number of stones, and associated comorbidities.

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          Epidemiology of urolithiasis in Asia

          Yu Liu, Yuntian Chen, Banghua Liao … (2018)
          In Asia, about 1%–19.1% of the population suffer from urolithiasis. However, due to variations in socio-economic status and geographic locations, the prevalence and incidence have changed in different countries or regions over the years. The research for risk factors of urinary tract stones is of predominant importance. In this review, we find the prevalence of urolithiasis is 5%–19.1% in West Asia, Southeast Asia, South Asia, as well as some developed countries (South Korea and Japan), whereas, it is only 1%–8% in most part of East Asia and North Asia. The recurrence rate ranges from 21% to 53% after 3–5 years. Calcium oxalate (75%–90%) is the most frequent component of calculi, followed by uric acid (5%−20%), calcium phosphate (6%−13%), struvite (2%−15%), apatite (1%) and cystine (0.5%−1%). The incidence of urolithiasis reaches its peak in population aged over 30 years. Males are more likely to suffer from urinary calculi. Because of different dietary habits or genetic background, differences of prevalence among races or nationalities also exist. Genetic mutation of specific locus may contribute to the formation of different kinds of calculi. Dietary habits (westernized dietary habits and less fluid intake), as well as climatic factors (hot temperature and many hours of exposure to sunshine) play a crucial role in the development of stones. Other diseases, especially metabolic syndrome, may also contribute to urinary tract stones.
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            The vesical calculus.

            M Stoller, Frederic Schwartz (2000)
            Bladder calculi account for 5% of urinary calculi and usually occur because of foreign bodies, obstruction, or infection. Males with prostate disease or previous prostate surgery and women who undergo anti-incontinence surgery are at higher risk for developing bladder calculi. Patients with SCI with indwelling Foley catheters are at high risk for developing stones. There appears to be a significant association between bladder calculi and the formation of malignant bladder tumors in these patients. Transplant recipients are not at increased risk for developing vesical calculi in the absence of intravesical suture fragments and other foreign bodies. Patients who undergo bladder-augmentation procedures using a vascularized gastric patch appear to be protected from vesicolithiasis, perhaps by the acidic environment. Ileum and colon tissues, however, are colonized by urease-producing organisms, producing an alkaline pH that promotes stone formation. Children remain at high risk for bladder-stone development in endemic areas. Diet, voiding dysfunction, and uncorrected anatomic abnormalities, such as posterior urethral valves and vesicoureteral reflux, predispose them to bladder-calculus formation. Finally, there are a number of techniques and modalities available to remove bladder stones. Relieving obstruction, eliminating infection, meticulous surgical technique, and accurate diagnosis are essential in their treatment.
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              Epidemiology of urolithiasis.

              A Trinchieri (1996)
              The epidemiology of urolithiasis differs according to geographical area and historical period: changing socio-economic conditions have generated changes in the incidence and type of lithiasis in terms of both the site and the physical-chemical composition of the calculi. Reno-ureteral calculosis typical of adult age and featuring mainly calcium oxalate and phosphate is currently more frequent in economically developed countries, where the prevalence rate hovers between 4% and 20% and the annual incidence of hospitalization for calculosis ranges from 0.03 to 0.1%. On the contrary "primitive" vesical calculosis is fairly widespread in Asia, with calculi composed of ammonium urate and calcium oxalate. Vesical calculosis, due to malnutrition in the very early years of life, is currently frequent in huge areas of Turkey, Iran, India, China, Indochina and Indonesia, although the incidence is decreasing in proportion as social conditions gradually improve. At the beginning of the 20th century primitive vesical calculosis was relatively frequent in Europe also, but in the course of the last 100 years, there has been a gradual decrease in its incidence, while the reno-ureteral calculosis has become more common. This trend definited as "stone wave" has been explained in terms of changing social conditions and the consequent changes in eating habits. In Europe, Northern America, Australia, Japan, and, more recently, Saudi Arabia affluence has spread to all social classes, and with it the tendency to eat "rich" food in large quantities. Calcium oxalate and/or phosphate stones account for almost 70% of all renal stones observed in economically developed countries. The prevalence of this type of stones varies considerably on account of environmental factors, especially dietary intake and lifestyle, while radiolucent and infection stones seem to be less influenced by environmental conditions. In the seventies the pathogenetic role for calcium oxalate stones of a diet rich in proteins, refined carbohydrate and sodium has become evident, while the effect of alimentary calcium and oxalate is still debated. However, the concurrence of a genetic predisposition seem to be crucial for calcium stone formation. In fact the importance of family history for idiopathic calcium stone disease is clearly demonstrated, although little is known about the metabolic alterations underlying this predisposition and their genetic transmission mechanisms.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Pract Cases Emerg Med
                Journal ID (iso-abbrev): Clin Pract Cases Emerg Med
                Title: Clinical Practice and Cases in Emergency Medicine
                Publisher: University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine
                ISSN (Electronic): 2474-252X
                Publication date Collection: November 2020
                Publication date (Electronic): 23 September 2020
                Volume: 4
                Issue: 4
                Pages: 544-547
                Affiliations
                [* ]Darbhanga Medical College and Hospital, Department of Surgery, Darbhanga, India
                [† ]Hamdard Institute of Medical Sciences and Research, New Delhi, India
                [‡ ]Kern Medical Center, Department of Emergency Medicine, Bakersfield, California, United States of America
                Author notes
                Address for Correspondence: Tariq Hameed, MBBS, MS, Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, PIN- 110062. Email: drtariqhameed@ 123456gmail.com .
                Article
                Publisher ID: cpcem-04-544
                DOI: 10.5811/cpcem.2020.7.47653
                PMC ID: 7676780
                PubMed ID: 33217268
                SO-VID: 99f8be48-2c0e-459b-9eec-69249fb835e2
                Copyright © Copyright: © 2020 Vidhyarthy et al.
                License:

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 11 April 2020
                Date revision received : 22 July 2020
                Date accepted : 22 July 2020
                Categories
                Subject: Case Report

                Keywords: giant vesical calculus,gross hematuria,suprapubic cystolithotomy
                Data availability:
                Keywords: giant vesical calculus, gross hematuria, suprapubic cystolithotomy

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