Giant Bladder Calculus: Case Report and Literature Review

Background: The existence of calculi in the urinary tract are well known urological conditions. A giant bladder calculus is one weighing more than 100g and is a rare finding in present-day urological practice. Case summary: The patient is a 58-year-old man who presented with a 20year history of progressive irritative Lower Urinary Tract Symptoms (LUTS) associated with poor stream which improves with change in posture. He had episodes of intermittent painful terminal haematuria and pyuria with occasional fever. About three months to his presentation, he developed progressively worsened constipation. He also had weight loss and anorexia. On examination, His vital signs were normal. There was a suprapubic mass about 6cm above pubic symphysis, smooth surface, hard, mobile and bi-manually palpable. The prostate was not enlarged on digital rectal examination. His Abdominopelvic ultrasound scan and KUB revealed a giant bladder calculus with bilateral hydronephrosis. Urine Microscopy, Culture and Sensitivity (M,C,S) showed numerous red blood cells, pus cells, and cultured Klebsiella spp sensitive to Ciprofloxacin. Serum Electrolytes, Urea and Creatinine were normal. He was treated for Urinary tract infection then had cystolithotomy. Intraoperative findings were a giant bladder calculus, thickened bladder wall and hyperaemic bladder mucosa. The bladder mucosal biopsy revealed chronic inflammation on histology. The calculus weighed 1000g. Post-operative recovery was uneventful, the catheter was removed and the patient was discharged home 2 weeks after surgery with resolution of all lower urinary tract symptoms. He had remained symptom-free in his last follow up visit which was 1year post operation. Conclusion: A giant bladder calculus is a rare finding in contemporary urological practice.