A rare case of urachovesical calculus: a diagnostic dilemma and endo-laparoscopic management

Urachal anomaly in an adult is extremely rare, as the majority of urachal remnants obliterate shortly after birth. A 55-year-old man presented with irritative voiding symptoms. A plain film demonstrated a radiopaque shadow in the region of the urinary bladder. Ultrasonography showed a fixed echogenic focus in relation to the anterior bladder wall. With these investigations, the patient was referred to us with a diagnosis of a vesical stone. We suspected it to be a case of a urachal calculus. Therefore, a CT scan of the pelvis was obtained, which showed a midline tubular tract containing a cylindrical stone, further extending into the bladder as a pedunculated stone. The patient was managed by a combination of endoscopic and laparoscopic techniques. A urachovesical stone like a cherry (pedunculated) has not been reported previously in the English-language literature. This case also illustrates for the first time the combined use of endoscopy and laparoscopy to retrieve a urachovesical stone and the excision of the urachus.