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Benign prostatic hyperplasia often produces chronic and progressive lower urinary tract symptoms or complications such as bladder stone, leading to retention of urine and to seek medical attention. Becharetal1 stated giant urinary bladder stone weighing 100 grams or more are uncommon. In our case 162 grams of bladder stone with few another stones about 10-15 grams in the left lower end of ureter were removed. Available treatment options for vesical calculus include open surgical removal, extracorporeal fragmentation and endoscopic crushing. Recently endo-surgical mechanical cystolithotripsy followed by percutaneous extraction has been in clinical practice for small and moderate sized calculus.
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Las litiasis vesicales de gran tamaño son infrecuentes. Se manifiestan clínicamente por sepsis urinaria a repetición, polaquiuria y estranguria. Se presenta un nuevo caso de litiasis vesical gigante, así como aspectos de su diagnóstico y tratamiento. La paciente de 64 años de edad, asistió a la consulta y refirió padecer de infecciones urinarias reiteradas, incontinencia por urgencia miccional y dolor posmiccional en hipogastrio y uretra. Tenía el antecedente de haber sido operada, siete meses atrás, de un prolapso uterino total por vía vaginal. En el cultivo de orina se aisló Escherichia coli y, en el ultrasonido abdominal, se detectó una litiasis vesical de gran tamaño, la cual se confirmó en la radiografía simple de la pelvis. Se le realizó la cistolitotomía retropúbica, extrayéndose una litiasis de 9 x 6 x 5 cm de tamaño y 186 g de peso. La paciente evolucionó favorablemente con la desaparición total de los síntomas. La litiasis vesical gigante es rara, pero se debe sospechar en pacientes con síntomas urinarios sépticos e irritativos bajos persistentes. El ultrasonido del tracto urinario y la radiografía simple de la pelvis, son suficientes para establecer el diagnóstico de certeza. La cistolitotomía continúa siendo el tratamiento de elección de esta afección.
Giant bladder calculi are uncommon. Their clinical manifestations are recurrent urinary sepsis, polachiuria and strangury. A new case is presented of giant bladder calculus, as well as aspects of its diagnosis and treatment. A 64-year-old female patient attended consultation and stated that she suffered from recurrent urinary infection, urinary urgency incontinence and hypogastric and urethral post-miction pain. Seven months before she had undergone surgery for total uterine prolapse via the vagina. Escherichia coli was isolated from the urine culture, and abdominal ultrasonography revealed a large bladder calculus, which was confirmed by simple pelvic radiography. Retropubic cystolithotomy resulted in the removal of a 9 x 6 x 5 cm, 186 g calculus. The patient evolved favorably with total disappearance of all symptoms. Giant bladder calculus is a rare condition which should be suspected in patients with persistent irritative symptoms of lower urinary sepsis. Urinary-tract ultrasonography and simple pelvic radiography are sufficient to establish the certainty diagnosis. Cystolithotomy continues to be the treatment of choice for this condition.
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Background: Urolithias is the process of formation of stones in the kidney, bladder and urethra is a complex phenomenon yet not clearly understood. It is a condition distributed worldwide and it is dependent on socioeconomic conditions that have generated changes in the prevalence, incidence and distribution. We report a giant calculus that we came across during routine dissection of a 60 year old female cadaver in the Department of Anatomy. This cadaveric calculus is reported for the rarity of size of the calculus in modern times, with improved diagnosis and management.
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Objective To evaluate the clinical effect and safety of ureteroscopic pneumatic lithotripsy combined with transurethral resection of prostate(TURP)for treatment of benign prostatic hyperplasia(BPH)with bladder calculus.Methods 68 patients of BPH with bladder calculus treated by ureteroscopic pneumatic lithotripsy combined with transurethral resection of prostate were reviewed.Results Satisfactory effects were achieved in all these 68 cases without serious complications.Conclusion Ureteroscopic pneumatic lithotripsy combined with TURP is a minimally invasive,safe and effective method in the treatment of BPH and bladder calculus.
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Objective To evaluate the efficacy and safety of holmium laser lithotripsy for the treatment of urinary calculi.Methods A total of 1216 cases of urinary calculi underwent ureteropyeloscopic and cyctocopic holmium laser lithotripsy.There were 1 006 cases of ureteral stones(302 cases of upper ureteral stones,364 cases of middle ureteral stones,and 340 cases of lower ureteral stones) and 210 cases of bladder stones.Results In 1 case of upper ureteral stones,failure to access the ureteral orifice due to enlarged prostate was encountered,and extracorporeal shock wave lithotripsy(ESWL) was employed.In 1006 cases of ureteral stones,the rate of successful fragmentation on single session was 95.5%(961/1 006),with 89.4%(270/302),96.4%(351/364),and 100%(340/340) for upper,middle,and lower ureteral stones,respectively.Ureteral perforation was encountered during lithotripsy in 6 cases.In 210 cases of bladder stones,the rate of successful fragmentation on one session was 100%(210/210).No bleeding or bladder perforation was observed during lithotripsy.Follow-up checkups for 0.5~40 months(mean,18.6 months) in 881 cases of ureteral stones showed that the stone-free rates were 91.1%(224/246),98.5%(318/323),and 100%(312/312) for upper,middle,and lower ureteral stones,respectively.The overall stone-free rate for all levels of ureteral stones achieved 96.9%((854/881)).Ureteral stenosis was found in 6 cases.Follow-up checkups for 0.5~31 months(mean,12.4 months) in 187 cases of bladder stones revealed a stone-free rate of 98.4%(184/187). Conclusions Holmium laser lithotripsy is a highly effective,minimally invasive,and safe therapy for urinary calculi.It is indicated as the first choice of treatment for patients with ureteral stones and bladder stones.
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We report a case of gall stone ileus in which the calculus was initially impacted in the small gut causing small gut obstruction. On follow up, CT demonstrated the calculus in the rectum confirming its spontaneous passage. The spontaneous passage of obstructing gall stone is an extremely rare entity.
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Objective To investigate a new method of pneumatic ballistic lithotripsy for the treatment of bladder calculi. Methods A ureteroscope or nephroscope was inserted into the bladder via outer sheath of resectoscope. Then pneumatic ballistic lithotripsy was performed under endoscope to fragment and remove bladder stones. Results Stones were thoroughly removed from the bladder on one session in all 20 patients. No major haemorrhage, perforation of the bladder, or water intoxication happened intraoperatively or postoperatively. Follow-up for 2~18 months (mean, 4 6 months) in the 20 patients showed no recurrence of calculi under B-ultrasonography or symptoms of urethral stricture like dribble urination. Conclusions Pneumatic ballistic lithotripsy via outer sheath of resectoscope is effective in the treatment of bladder calculi.
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Objective To discuss the technique and therapeutic effect of pneumatic ballistic lithotripsy for the treatment of bladder calculi under ureteroscope via the outer sheath of resectoscope.MethodsTotally 42 patients with bladder calculi(39 men and 3 women)were treated in our hospital form March 2002 to February 2005.Among the patients,20 cases were complicated with BPH,and 3 had bladder fabrosis.The cystolith was crushed with pneumatic ballistic lithotripsy under an ureteroscope via the outer sheath of resectoscope.For the patients complicated with BPH(20 cases),prostatectomy was performed at the same time.ResultsAll the cases were cured in one session.No massive hemorrhage,bladder perforation,or overhydration occurred after the operation in this series.The patients were followed up for 6 to 18 months(mean 8 months),during which no recurrent cases were found,all the patients had normal urination.ConclusionsPneumatic ballistic lithotripsy via the outer sheath of resectoscope is an effective,simple,accurate method for the treatment of bladder stones.The procedure is superior in less complications and good outcomes.
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Objective To explore the efficacy of transurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy for bladder calculus.MethodsBy using transurethral F20.8 nephroscope and EMS LithoCaster,we performed transurethral nephroscopic pneumatic lithotripsy and ultrasound lithotripsy on 69 patients with bladder calculus(63 men and 6 women)between October 2005 and May 2008.The diameter of the calculi was ranged from 1.5 to 6.0 cm.Among the patients,42 had one stone in the bladder,while 27 had multiple calculi.Fifty-five patients were complicated with BPH,14 had neurogenic bladder,and 4 showed bladder diverticulum with stones in situ.Pneumatic frequency was set at 8-12 Hz,and ultrasonic energy was 50%-60%.For the patients with BPH electrovaporization ablation was plused.ResultsAmong the 69 patients,68 were cured in one session.The mean operation time was 25 minutes(15 to 40 minutes).One patient was converted to open surgery because of rupture of the bladder during the procedure.No patient had urethral stricture,infection,or massive hemorrhage during the operation.Follow-up was available in 68 patients for 6 to 10 months(mean,9 months).During the period,no recurrent calculi was found by ultrasonography and X-ray.ConclusionTransurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy is effective for bladder calculus.
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A rare case of dermoid cyst of the urinary bladder with a calculus is presented. The patient was admitted, diagnosed, and operated on for the calculus. The dermoid cyst was found only during the operation.(Summary)