Giant Urinary Bladder Calculi in Calabar-Nigeria: A Case Report

Abstract

Background: Urolithiasis remains a common urological problem in many parts of the world. Physiological as well as pathological changes in the body accounts for the development of urinary stones. Most of the stones formed in the kidney eventually pass out of the urinary system in the urine. Some stones, however, may get attached to a nidus and continue growing until they are removed by surgical intervention. In most of the developed world, medical intervention takes place early when the stones can be removed by conservative medical expulsive therapy or by minimally invasive techniques using ureteroscopy and laser stone fragmentation. Where such stones are not removed early in their formative stages, they could grow increasingly larger, especially in the urinary bladder, and open surgical intervention by cystolithotomy would then be needed for their removal. It is now very unusual to have giant urinary stones with diameters exceeding 5 cm. Case Presentation: We present a case report of the largest documented bladder calculi removed in Africa by open vesicolithotomy from a 40-year-old rural dweller in South-Southern Nigeria. The patient presented with a 5-year history of obstructive and irritative lower urinary tract symptoms, associated with a progressive hard supra-pubic swelling. Physical examination revealed a stony hard supra pubic mass and the plain abdomino-pelvic radiograph showed a giant bladder calculus. At open cystolithotomy, a giant calculus measuring 10 × 10 × 9 cm was removed along with a 6 other associated calculi. Post operative recovery was uneventful. Histology of a biopsy of the 5 cm, hypertrophic bladder wall and epithelium, was negative for malignancy. Challenges of case management are highlighted and pictorial displays relevant to the case is shown. Conclusion: Giant bladder stones are rarely seen in most of the developed world. Their diagnosis is usually associated with patients who have no access to health care or those who are managed in societies where specialist care and facilities for investigation are unavailable. Treatment usually is by open vesicolithotomy and biopsy of any areas suspicious for traumatic metaplasia should always be taken.