|Year : 2018 | Volume
| Issue : 2 | Page : 147-149
Giant bladder stone with foreign body and associated carcinoma urinary bladder
MS Faridi, Naloh Mibang, Md Jawaid Rahman, Rajendra Sinam Singh
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||25-Oct-2018|
Dr. M S Faridi
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
Bladder stones comprise 5% of urinary tract stones. Males are affected more than females. In general, they occur in the presence of bladder neck obstruction and urinary tract infections associated with neurogenic bladder. A giant vesical calculus of more than 100 g is rare. The metallic foreign body within the stone core and associated cancer urinary bladder is a rare combination. This case emphasizes the fact that a proper history and examination is really important in diagnosis.
Keywords: Bladder cancer, bladder stone, cystolithotomy, foreign body, vesical calculi
|How to cite this article:|
Faridi M S, Mibang N, Rahman MJ, Singh RS. Giant bladder stone with foreign body and associated carcinoma urinary bladder. J Med Soc 2018;32:147-9
|How to cite this URL:|
Faridi M S, Mibang N, Rahman MJ, Singh RS. Giant bladder stone with foreign body and associated carcinoma urinary bladder. J Med Soc [serial online] 2018 [cited 2019 Apr 20];32:147-9. Available from: http://www.jmedsoc.org/text.asp?2018/32/2/147/236150
| Introduction|| |
Giant vesical calculus weighing more than 100 g is rare. Recognized causes of bladder stone formation are bladder diverticulum, neurogenic bladder, urinary tract infection, prostatomegaly, and foreign body in the bladder. We report a case of foreign body in the bladder with associated bladder stone and squamous cell carcinoma (SCC) of the urinary bladder.
| Case Report|| |
A 48-year-old male patient who is a chronic smoker presented with complaints of the left flank pain with fever for past 20 days. He also had loss of appetite and weakness for the past 1 month.
On examination, the patient was anemic but the vitals were normal. Abdominal examination was normal. On digital rectal examination, the prostate was normal with a hard mobile mass felt anteriorly. Laboratory investigation revealed hemoglobin 6 g% and total leukocyte count 18,900 cells/mm3 with deranged kidney function test (blood urea 80 mg/dl, serum creatinine 4.0 mg/dl). Urine shows plenty of pus cells/hpf and no red blood cells. Abdominal ultrasound revealed a bladder calculus (7.44 cm × 5.54 cm) along with a growth measuring 5 cm × 4 cm in the right lateral wall of the urinary bladder with bilateral hydroureteronephrosis (left more than right). Plain radiograph of pelvis revealed a large laminated radiopaque calculus occupying the urinary bladder with evidence of more dense opacity within the calculus suggesting a foreign body [Figure 1] with no other radiopaque shadow in kidney or ureter. Noncontrast computed tomography scan showed 9 cm × 8 cm radiopaque shadow in the bladder with growth in the right posterolateral wall of urinary bladder 5 cm × 5 cm [Figure 2]. Retrospectively confirming the history of the foreign body, the patient revealed about inserting small metallic object per urethra while trying to masturbate at the age of 13 years; since then, he does not remember passing out that metallic object in urine.
|Figure 1: X-ray of kidneys, ureters, and bladder shows laminated radiopaque calculus (red arrow) and more dense foreign body within calculus (blue arrow)|
Click here to view
|Figure 2: Computed tomography scan showed calculus with the right posterolateral wall SOL (yellow arrow)|
Click here to view
Per urethral catheterization was conducted and the left kidney was drained percutaneously. The patient was treated with antibiotic as per the urine culture report. After treating the urinary tract infection and anemia and building up the nutritional status, an open cystolithotomy operation was planned. During surgery, a large hard brownish calculus weighing 480 g and size 8 cm × 6 cm × 6.5 cm [Figure 3] was found, and biopsy of bladder growth was taken. The patient was lost to follow-up.
Histopathology showed SCC of the urinary bladder.
| Discussion|| |
Calculus disease of the urinary system is known since a long time. The established etiologies of bladder stone are urinary tract infection, obstruction to the urinary tract, prostatomegaly, and foreign bodies. Foreign bodies may be introduced into the bladder by penetrating injuries or, as in our patient, by self-insertion, which is usually a result of eroticism.
Open suprapubic cystolithotomy is the treatment of choice in the management of giant bladder calculus.
SCC of urinary bladder occurs most commonly in the seventh decade of life, but this patient presented at the age of 48 years. Most patients with SCC of the bladder present with hematuria, but it was absent in this patient. This patient presented with unusual symptoms such as irritative bladder symptoms, weight loss, loss of appetite, and urinary obstruction.
Localized SCC is usually treated surgically as these tumors may be resistant to chemotherapy and radiotherapy, similar to SSCs of other sites. Prognosis of SCC bladder is poor, and most of the people die within 1–3 years of diagnosis. Death is usually due to locoregional progression, and distant metastases are rare. In this case, the patient lost to follow-up, so definitive treatment was not conducted.
| Conclusion|| |
Proper and detailed history examination is important for the diagnosis.
In this case, the foreign body acts as a nidus for bladder stone formation and chronic urothelial irritation resulted in SCC of the urinary bladder.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Becher RM, Tolia BM, Newman HR. Giant vesical calculus. JAMA 1978;239:2272-3.
Benway BM, Bhayani SM. Lower urinary tract calculi. In: Wein AJ, editor. Campbell-Walsh Urology. 10th
ed., Ch. 89. Philadelphia, PA: Saunders Elsevier; 2011.
Tiwari P, Tiwari M, Chhabra B, Yadav Y. A rare giant vesical calculus: Case report with review of literature. Sch J Med Case Rep 2014;2:499-501.
Loeser A, Gerharz EW, Riedmiller H. Chronic perforation of the urinary bladder by self-inserted foreign body. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:689-90.
Chen S, Kao Y, Tse S. A giant bladder stone. J Tua 2003;14:201-3.
Rogers CG, Palapattu GS, Shariat SF, Karakiewicz PI, Bastian PJ, Lotan Y, et al
. Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder. J Urol 2006;175:2048-53.
[Figure 1], [Figure 2], [Figure 3]