Expanding the limits of vaginal surgery: Transvaginal vesicolithotomy for an incarcerated procidentia: A case report and literature review.

Bladder stones are rare in women. This report presents the case of a woman with a massive bladder stone and incarcerated procidentia. The 75-year-old woman presented to the outpatient clinic with procidentia and recurrent urinary tract infections. Preoperative imaging led to the diagnosis of cystolithiasis. After multidisciplinary counseling the patient underwent a vaginal hysterectomy with bilateral oophorectomy and transvaginal vesicolithotomy. A bladder biopsy was performed to rule out any malignancy. After three days, the patient was discharged with a Foley catheter; 15 days later, the bladder catheter was removed. She had an uncomplicated postoperative course. The presence of cystolithiasis and pelvic organ prolapse remains a challenge both in diagnosis and in treatment. The literature lacks solid evidence on the optimal management of these cases. Although there are no recommendations or consensus for their treatment, it seems that the one-step vaginal approach is preferable to the abdominal route.

Complicated Case of a Giant Bladder Stone and Forgotten Double-J (DJ) Stent in an Otherwise Healthy Elderly Patient: A Case Report.

Giant bladder stones, defined as stones weighing over 100 g and/or measuring more than 4 cm in diameter, are relatively uncommon compared to other types of urinary tract stones. This patient, an 85-year-old male with an unknown medical history, initially presented with urinary incontinence and hematuria. Radiological findings revealed a large prostate, a forgotten left renal double-J (DJ) stent for more than 20 years with an encrusted bladder stone, and additional calculi in the lower pole of the left kidney. The patient underwent laser cystolithotripsy, but due to the complexity of the case, a second procedure was scheduled. Following the second procedure, the patient experienced a generalized tonic-clonic seizure and subsequent loss of consciousness, which was attributed to hyponatremia. The patient received appropriate management to correct hyponatremia and antiepileptic medication to control the seizure. The patient's condition eventually improved and he was discharged home with prescribed medications and follow-up appointments. This case emphasizes the potential complications of giant bladder stones and a forgotten DJ stent in an 85-year-old male patient as a rare consequence following such a rare presentation.

Big bladder stone accompanied by big posterior urethral stone: A management of rare case report.

INTRODUCTION AND IMPORTANCE: Urinary tract stones are a common disease, but concurrent large-size stones in the bladder and urethra are rare. This phenomenon can lead to obstruction, infection, and other complications. We reported the management of a rare case of a giant bladder stone accompanied by a big posterior urethral stone. CASE PRESENTATION: A 36-year-old man with a chief complaint of not being able to have spontaneous micturition, frequent expulsion of stones from the penis, and a history of hematuria. Bladder examination revealed a giant bladder stone of 1278 Hounsfield Unit (HU) with a size of 4.1 × 7.2 cm, and urethral examination revealed a stone of 1275 Hounsfield Unit (HU) with a length of 4.3 × 4.2 cm, without mass. This patient underwent vesicolithotomy and urethrotomy. The evaluation showed spontaneous micturition and dissolved hydronephrosis. CLINICAL DISCUSSION: Urinary tract stone management primarily involves endourology or open surgery. For smaller stones (<5-6 mm), medication is sufficient, as they often pass spontaneously. Larger stones may require interventions like vesicolithotomy or urethrotomy. Vesicolithotomy is preferred for complex or large bladder stones, while urethrotomy is performed if the stone location is palpable or seen on imaging. These procedures are practical options for general surgeons in first-level hospitals. CONCLUSION: Concurrent large bladder and urethral stones are uncommon. Endourology or open surgery is typically employed. Treatment selection should be personalized to individual patient assessment to mitigate potential complications effectively.

Extraction of a giant bladder stone (560 g) in a young female: A case report.

INTRODUCTION AND IMPORTANCE: Giant bladder stones, exceeding 100 g, are rare and typically affect males. This report describes an atypical case of a 35-year-old female with a 560-g bladder stone causing acute kidney injury without evidence of upper urinary tract stones. CASE PRESENTATION: A 35-year-old female presented with pelvic pain and urinary retention. Comprehensive imaging, including a KUB x-ray and subsequent ultrasound, revealed a giant bladder stone obstructing the ureters and causing bilateral hydronephrosis. Urinalysis showed a severe urinary tract infection. Given the stone's significant size and its firm attachment to the bladder wall, open cystolithotomy was performed. The patient recovered well and was subsequently discharged without postoperative complications. CLINICAL DISCUSSION: Giant bladder stones are rare in young females. This case highlights the uncommon presentation of a 560-g stone in a female, causing acute kidney injury while there were no upper tract stones detected. The role of urinary tract infection as a contributing factor is explored, although other etiological factors are also considered. CONCLUSION: Open cystolithotomy proved to be an effective treatment. Postoperative recommendations included dietary modifications to minimize the risk of recurrence. This case expands our knowledge of giant bladder stones in this population.

Secondary bladder stone caused by delayed penetration of the bladder by a pubic fracture: A case report and literature review.

Pelvic fractures sometimes lead to injuries of the urinary bladder, which commonly present as gross hematuria, dysuria and lower abdominal pain. As a type of urinary stone, bladder stones are usually secondary to lower urinary tract obstruction, such as benign prostatic hyperplasia, urethral stricture, and neurogenic bladder. The present case report examines an unusual case of a delayed pubic fracture penetrating the bladder, which caused a secondary bladder stone. A 53-year-old man was first hospitalized at The Second Hospital of Jiaxing (Jiaxing, China) in January 2020 because of trauma-induced bleeding in the scalp and abdominal pain. The patient underwent abdominal exploration and partial bowel resection, and his condition stabilized after surgery. After discharge, the patient had regular outpatient check-ups every 2-3 weeks. However, after 3 months, in April 2020, the patient was readmitted to the hospital because of frequent urination, an urgent need for urination and dysuria. Abdominal computed tomography imaging and cystoscopy revealed a pubic fracture that had penetrated the bladder wall, accompanied by a bladder stone. Subsequently, cystolithotomy was performed, which provided significant relief of symptoms once the catheter was removed after 2 weeks. Since then, the patient has been followed up until January 2023 and had remained asymptomatic. Bladder stones caused by necrotic bone fragmentation are rare. Bladder injuries resulting from pelvic fractures can have delayed onset; therefore, clinicians should be aware of the possibility of urogenital injury in such patients. It is crucial for clinicians to comprehend the potential mechanisms involved, analyze the clinical data of patients, closely monitor their condition and implement appropriate treatment measures when necessary.

A seed link connector protruding into the bladder formed a bladder stone.

Introduction: Low-dose-rate brachytherapy is performed for localized prostate cancer. We report the first case of a bladder stone encompassing the seed migrated into the bladder in a patient treated with low-dose-rate brachytherapy. Case presentation: A man was diagnosed with prostate cancer and underwent low-dose-rate brachytherapy. After 2 months, dysuria occurred, and ultrasonography revealed a needle-shaped high-intensity protruding from the prostate into the bladder. Cystoscopy examination found a seed link connector. With the possibility of natural dissolution of the seed link, careful observation was chosen. However, 16 months later, hematuria occurred, and an X-ray revealed a bladder stone encompassing the seed. Compared with the X-ray right after seeding, the seed located near the right bladder neck had fallen. The seed was removed by transurethral bladder lithotripsy. Conclusion: Seeds should be carefully located within the prostate, otherwise a bladder stone may be formed encompassing the seed.

Primary intravesical insertion of intrauterine device for 10 years: Clinical presentation and outcome.

Intrauterine device (IUD) is considered the second most widely used method of contraception. Migration of the IUD into the urinary system has been reported. Nevertheless, a missed IUD which is mistakenly inserted into the bladder has rarely been reported. We report a female patient experienced recurrent urinary tract infection (UTI) for 10 years without appropriate evaluation. The underlying problem was an IUD that inserted into the bladder led to the formation of bladder stone. The clinical course and the endoscopic management of the stone and the IUD is reviewed in this case report.

Bladder Stone Formation due to Intravesical Migration of the Intrauterine Device: A Report of 2 Cases.

INTRODUCTION: Approximately 5% of bladder stones occur in women and are usually associated with foreign bodies or urinary stasis. Spontaneous migration of the intrauterine device (IUD) into the bladder is a rare complication. In this report, we present 2 cases of migrated IUD who had undergone surgery at our clinic due to bladder stones. CASE PRESENTATIONS: We detected migrated IUDs into the bladder in 2 female patients, aged 37 and 56 years, who presented with lower urinary tract symptoms and urinary tract infection. In the first case, endoscopic cystolithotripsy was performed, and the IUD was removed without complications. In the second case, the IUD could not be removed endoscopically since it had fractionally invaded the bladder wall, and the IUD was removed without complications by performing an open cystolithotomy. CONCLUSION: A comprehensive gynecological history should be taken from every female patient presenting with recurrent urinary tract infections and lower urinary tract symptoms. If these patients have a history of IUD placement, the possibility of the intravesical migration of this device should be kept in mind.

Bicentric retrospective study comparing the postoperative outcomes of patients treated surgically for bladder stones with or without concomitant surgery for BPH.

PURPOSE: To compare the postoperative outcomes of male patients who underwent bladder stone (BS) removal, with or without concomitant benign prostatic hyperplasia (BPH) surgery. PATIENTS AND METHODS: All men aged > 50 years who underwent BS removal at two French university hospitals between 2009 and 2018 were retrospectively reviewed. Four binary outcome criteria were identified during the follow-up: early postoperative complications, stone recurrence, subsequent surgery for BS or BPH, and late surgical complications. A composite score ranging from 0 to 4 was calculated by combining the four criteria. RESULTS: A median follow-up period of 42 months was observed in 179 patients. Of these, 107 patients were in the "concomitant surgical treatment" (CST) group and 72 in the bladder "stone removal alone" (SRA) group. The CST group presented higher baseline post-void residual volume (105 vs. 30 ml, p = 0.005). Patients who underwent CST had a significantly lower rate of BS recurrence (12% vs. 39%; p = 0,001) and underwent fewer subsequent surgeries (14% vs. 44%; p < 0.001). There was no significant difference in the early (51% vs. 35%, p = 0,168) and late (26% vs. 17%, p = 0,229) complications rates between the two groups. A better composite score was observed in the CST than in the SRA, but the difference was not significant (3.07 vs. 2.72, p = 0.078). CONCLUSION: As CST increases morbidity and decreases the risk of reoperation, each situation should be considered, taking into account patient choice and comorbidities.

Thulium fiber laser cystolithotripsy under local anesthesia: A day care procedure.

INTRODUCTION: Bladder stones account for 5% of all urolithiasis. Patients present with LUTS or acute urinary retention. Thus, warranting an early intervention. Minimally invasive approach with laser lithotripsy is the present gold standard to treat bladder stones. AIMS AND OBJECTIVES: To evaluate the outcomes of TFL (60 W) for bladder stones performed under local anesthesia as a day-care procedure. MATERIALS AND METHODS: This was a retrospective single-center study conducted after obtaining IRB approval. Study period was between June 2021 and June 2022 were included. All patients were operated under local anesthesia as a day care procedure. The procedure was carried out using an 18 Fr laser sheath and calculus dusted using TFL energy (15-30 W). Parameters including operative time in minutes, complications were recorded. Patients were encouraged oral and normal voiding in the immediate post-op period. RESULTS: A total of 47 patients with bladder stones presented during this period. Of these, 30 underwent laser lithotripsy (TFL) for bladder calculi. The clinical presentation of patients was LUTS in 28 (93%) and 5 (16%) patients had AUR. The average size of the stone in this series was 15 ± 2.8 mm. The mean duration of laser lithotripsy was 15 ± 5.4 min. Energy to dust the stone was variable with mean LASER energy of 18.23 ± 10 W. All patients tolerated the procedure well and none required conversion to conventional anesthesia. One patient failed to void in the post-op period. 100% clearance rate was documented in all patients. CONCLUSION: Thulium fiber laser for transurethral cystolithotripsy of bladder stones under local anesthesia is a feasible technique with minimal morbidity and good outcome.

Bladder stone formation around polyethylene glycol after use of SpaceOAR Hydrogel.

Introduction: Radiation therapy is used as primary, adjuvant, and salvage therapy for prostate cancer. When using radiation therapy, the SpaceOAR® system is considered easy to use and useful for reducing the irradiated dose and toxicity to the rectum. Although SpaceOAR® system have been reported some adverse event including death. Case presentation: A 74-year-old male was diagnosed with prostate cancer of clinical stage cT2aN0M0 and intermediate risk by the National Comprehensive Cancer Network guidelines. We inserted the SpaceOAR® Hydrogel before performing intensity-modulated radiation therapy, as the patient had ulcerative colitis. We did not recognize any complications during or after the procedure, although magnetic resonance imaging revealed hydrogel in the bladder retrospectively. Fourteen months after the procedure, the patient was presented with macrohematuria and we found a bladder stone including hydrogel. Conclusion: We report the first case of a bladder stone after use of SpaceOAR® Hydrogel. We must be careful of taking place it.

Bladder stone due to late clip migration after prostatic urethral lift procedure: A case report.

BACKGROUND: Prostatic urethral lift (PUL) therapy is an alternative to minimally invasive and other surgeries in younger patients who want to preserve their sexual and ejaculatory functions, and in elderly male patients with benign prostatic hyperplasia who cannot be anesthetized because of the risk of anesthesia. The procedure can be performed as an outpatient and without anesthesia, and complications are few and temporary. In long-term follow-up, encrustations that require retreatment are rarely seen. CASE SUMMARY: In our case, a 62-year-old prostate patient who had a PUL operation 8 years ago and had a stone on the PUL material near the bladder neck was treated. The patient's stone was removed by endoscopic cystolithotripsy using pneumatic fragmentation. Bipolar transurethral resection of the prostate was applied to the patient in the same session. After the patient's 7-year follow-up, the patient's complaints relapsed, and cystoscopy was performed again. In cystoscopy, stone formation adjacent to the wall was observed at the junction of the bladder neck to the left lateral wall. The stone was fragmented with a pneumatic lithotripter. CONCLUSION: Placing clips too close to bladder neck in the PUL procedure may result in clip migration.

Bladder stone formation due to neglected double J stent: a case report.

Introduction and importance: Double J (DJ) stents are commonly used in genitourinary procedures, but they can lead to complications including infection, hematuria, encrustation, and stone formation. The longer the duration of encrustation, the greater the risk of complications and renal dysfunction. Forgotten stents pose challenges for patients and can require endourological or open surgical procedures. Case presentation: A 40-year-old man with hypertension and coronary artery disease had a forgotten DJ stent for 3 years, causing suprapubic pain and dysuria. Kidney, ureter, and bladder (KUB) revealed a coiled DJ stent with a large bladder stone and encrustation, and an open cystolithotomy was successfully performed. Recovery was uneventful, and the patient was discharged without complication. Clinical discussion: Ureteral stents, including the DJ stent, are commonly used for urological conditions but can cause complications if retained beyond the intended timeframe. Optimal timing for stent removal is crucial, and patients' healthcare knowledge and adherence are critical to preventing retention. KUB X-ray can evaluate stent encrustation and bladder stones. Cystoscopy is the typical approach for stent removal, but supplementary interventions may be necessary. Open surgery was recommended for removing a large bladder stone and encrusted stent in this case. Conclusion: Timely removal of DJ stents is crucial to avoid complications. Extended retention can cause problems such as encrustation and stone formation. Patient education and adherence are essential to prevent retention and forgetfulness. This case report highlights the importance of careful management of patients with DJ stents for optimal outcomes and prevention of complications.

Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report.

The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.

Differential diagnosis of a calcified object from the South Tombs Cemetery at Amarna, Egypt.

OBJECTIVE: This paper provides a brief history of the publication of calcified biological objects and presents one that was present in the grave associated with a mature adult female buried in the South Tombs Cemetery at Amarna, Egypt (c. 1353-1332BCE). METHODS: Macroscopic examination revealed an ovoid object constructed of concentric layers of a coarse sand-like material oriented around a dense core that lacked evidence of parasites. Microscopic examination revealed the object is composed of densely, yet haphazardly packed, elongated octahedron shaped crystals with no evidence of cellular structures. Basic chemical analysis eliminated calcium carbonate as a constituent material. RESULTS: Based on comparison with previously published examples from the archaeological and clinical literature and careful differential diagnosis, it is suggested this object is a bladder stone. SIGNIFICANCE: A brief discussion of the implications of bladder stones on individual health and broader epidemiological constraints to illustrate the depth such discoveries can bring to our understanding of ancient lived experience concludes the work. LIMITATIONS: The burial of Ind. 286 was disturbed. The identification of a bladder stone presumes the stone would have been found within the pelvic cavity, which cannot be confirmed. Other graves in the vicinity of this grave were also disturbed. It is unlikely, but still possible, that the stone originated from another grave and was relocated to this grave after disturbance. Full chemical analysis was not possible. SUGGESTIONS FOR FUTURE RESEARCH: Radiographic and chemical analysis would provide more information to strengthen the certainty of the differential diagnosis.

Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report.

Giant prostatic calculi are rare with less than 20 cases reported in the literature so far. Here, we discuss the presentation, diagnosis, and surgical management of a 25-year-old male patient with giant prostatic stones associated with a large bladder stone resulting from an underlying neurogenic bladder secondary to spina bifida. The patient had a history of congenital spina bifida, hydrocephalus, and non-compliance with clean intermittent self-catheterization. The stones were diagnosed through imaging and cystoscopy, and open cystolithotomy was performed for stone removal. The patient had a successful postoperative recovery with improved renal function. The case highlights the association between prostatic calculi and bladder outlet obstruction, emphasizes the importance of addressing underlying conditions to prevent stone recurrence, and underscores the role of open surgery in managing large bladder stones accompanied by renal impairment.

Giant Bladder stone and rectal prolapse complication in pediatric patient: Case report and literature review.

INTRODUCTION AND IMPORTANCE: A giant bladder stone (BS) in the urinary tract system with a rectal prolapse complication is a rare urologic problem; it is even rarer in pediatric patients. In the case of bladder stone formation, a variety of steps result in a variety of stone compositions. This study aims to understand the rare disease course of a one-year-old patient with bladder and urethral stones and a rectal prolapse complication. CASE PRESENTATION: A one-year-old boy presented with an inability to urinate since morning. It was a recurring incident for about a year but never resolved. The patients experienced irregular diarrhea and difficulty eating and drinking. Anal inspection revealed prolapse recti. The laboratory investigation found leukocytosis and anemia with normal blood urea nitrogen and creatinine. Urine tests revealed leukocyturia and hematuria. A plain radiograph of the abdomen showed a round opacity around the pelvic area. Ultrasonography of the abdomen and urinary tract revealed a giant BS and severe bilateral hydronephrosis. Thus, a cystolithotomy procedure was performed, and an additional urethral stone was found. Obtained bladder stones with a size of 30 × 21 × 15mm, with 57 % of uric acid and 33 % of calcium oxalate. A manual reduction of the prolapsed rectum was also performed during surgery. There was no recurrence of the prolapsed rectum after surgery. CLINICAL DISCUSSION: BS is very rare in the pediatric population. The development of our case's stone composition starts with pure uric acid, which is later enveloped by calcium oxalate due to its lack of acidic atmosphere. Rectal prolapse occurs due to increased abdominal pressure caused by straining during urination. CONCLUSION: The pathogenesis of BS is multifactorial, with local and systemic factors. Early diagnosis and comprehensive history-taking are essential for BS management decisions. The management of BS depends on its size, composition, and symptoms.

Comparison of three techniques in bladder stone surgery: Which technique is more effective and safe?

Background: In our study, we aimed to compare the success and complication rates of percutaneous cystolithotripsy (PCCL), transurethral cystolithotripsy (TUCL), and Ho: YAG laser lithotripsy in the surgery of bladder stones that occurred due to various reasons. Patients and Methods: Patients diagnosed with single or multiple bladder stones with long axis larger than 2 cm, resulting for various reasons, were included in ou study. Sizes of the stones, cystolithotripsy and discharge times, catheter removal times, complications observed, and the visual pain scale (VPS) were retrospectively evaluated separately from the surgical techniques implemented for accompanying patients and their data. Results: TUCL (group 1) was implemented in 40, PCCL (group 2) was implemented in 44, and transurethral Ho: YAG laser lithotripsy (group 3) was implemented in 30 of the 121 patients included in the study. The bladder stone long axe group 1 average was 3,7 cm (2,2-5,3), group 2 average was 3,74 cm (2,1-5,1), and group 3 average was 3,7 cm (2,3-4,7). Urethral stricture evolved in two patients who underwent TUCL. A statistically significant difference was observed on behalf of PCCL in terms of operation time. There was significance in the Ho: YAG laser cystolithotripsy group in comparison with VPS scores. No significant differences were found in terms of age, stone size, urethral catheter removal times, and discharge times. The average follow-up time was 6 months. Conclusion: Although all three methods were quite successful in bladder stone surgery, average cystolithotripsy times were significantly low in the PCCL technique. Thinking that the most common cause of bladder stone is BPH, it is stated that the suprapubic inserted tube ease the bladder drainage during transurethral resection of the prostate (TUR-P). In this way, the duration of the most common accompanying surgeries is shortened and performed more safely.

A Rare Case of a Giant Bladder Stone Associated With Post-obstructive Renal Failure Managed by Open Cystolithotomy.

Urinary tract stones are found in many locations, such as in the kidney or ureter, and, less commonly, in the bladder. Bladder stones are solid calculi that are usually composed of calcified material, most commonly uric acid, and typically weigh less than 100 g. There is a higher prevalence of bladder stones in males than in females, which can be explained by the pathophysiology of how these stones are formed. Namely, bladder stones tend to form secondary to urinary stasis, such as in the setting of benign prostatic hyperplasia (BPH). However, bladder stones can form in otherwise healthy individuals without anatomic defects (e.g., urethral strictures) or urinary tract infections (UTIs). Foley catheters or any foreign bodies in the bladder can predispose to stone formation. Renal calculi, most commonly calcium oxalate or calcium phosphate in composition, can also travel through the ureter and get trapped in the bladder. The most significant risk factors for bladder stones include the presence of BPH and UTIs, both of which favor the development of additional layers of stone material. In exceptionally rare cases, bladder stones measure more than 10 cm in diameter and weigh more than 100 g. These entities have been referred to as giant bladder stones within the limited literature. Minimal data exist on the etiology, epidemiology, composition, and pathophysiology of giant bladder stones. We present the case of a 75-year-old male with a giant bladder stone composed of 100% carbonate apatite, measuring 10 cm × 6 cm and weighing 210 g.

Unusual case of bladder stone with an embedded scalpel blade.

ME is an 84-year old man who presented with a 3-year history of storage urinary symptoms associated with strangury. He had an open radical prostatectomy and direct visual internal urethrotomy 10 years prior to presentation for early prostate cancer and partial urethral stricture, respectively. A plain abdominal X-ray revealed a bladder stone in which there was an opaque foreign body embedded within the stone. A cystolithotomy was done, and the retrieved stone was cracked open, revealing a surgical blade.The patient had an uneventful recovery postoperatively.