Doctors remove Bladder Stone as big as an Ostrich Egg: NEJM Case Report

A 64-year-old patient in California visited hospital emergency department with a 3-day history of pain in the left flank and urinary retention and doctors found a large reason for his pain: a mineral stone nearly the size of an ostrich egg, according to a new report of the case.

The patient had undergone radical cystectomy and orthotopic neobladder construction with intestinal segments more than a decade earlier because of invasive bladder cancer. His physical examination revealed tenderness in the left flank. Computed tomography of the abdomen and pelvis showed an obstructing stone in the left proximal ureter (and a very large stone in the neobladder). The use of intestinal segments to create urinary diversions can lead to stone disease as a result of persistent bicarbonate loss in the urine, hyperoxaluria, and long-term colonization of urea-splitting bacteria in the urinary tract. Additional risks for stone formation in a continent urinary reservoir, such as in our patient’s neobladder, include urinary stasis, mucus production, and nonabsorbable surgical materials used to construct the substitute bladder. The stone in the left ureter was accessed by means of percutaneous nephrostomy with antegrade ureteroscopic assistance and was removed with the use of laser lithotripsy. The patient underwent an open neocystolithotomy to extract the neobladder stone, which was egg shaped which weighed a whopping 1.7 lbs. (770 grams) and measured 4.7 inches by 3.7 inches by 3 inches (12 by 9.5 by 7.5 centimeters.The composition of the stone was 20% struvite and 80% calcium phosphate. There was no postoperative complications in the patient although he continues to be monitored for stone recurrence.

The panel on the left shows a scan of the man's abdomen. The large white circle is the neobladder stone, and above it, a black arrow points to another stone in the man's left ureter. The middle panel shows the man's abdomen from the side, and the panel on the right shows the egg-shaped neobladder stone after it was surgically removed. Original Image
Credit: The New England Journal of Medicine ©2017

Most Bladder stones usually affect men aged 50 and above.They are mineral masses formed in the bladder and are usually too small to be seen with the naked eye usually.However, in certain cases the stones can be quite large, reaching an inch or more in diameter. According to Guinness World Records, the largest bladder stone reported till date is 7 inches long, 5 inches thick and 3.7 inches tall (17.9 by 12.7 by 9.5 cm), and weighed 4.2 lbs. (1.9 kg).The case report, has been published in The New England Journal of Medicine.

You can read the full case report by clicking on the following Link

http://www.nejm.org/doi/full/10.1056/NEJMicm1611578