Giant urinary bladder stone: incidental finding in (99m)Tc-DTPA renography

Area of Science:

• Urology
• Nephrology
• Pediatric Surgery

Background:

• A 27-year-old female with a history of lipomyelomeningocele presented with urinary incontinence.
• She previously underwent bladder augmentation enterocystoplasty at age 7, managed with intermittent catheterization.
• This management strategy had been successful in preventing urinary tract infections until the current presentation.

Observation:

• A Tc-DTPA renography was performed to assess renal function.
• The renography revealed an abnormal tracer distribution within the urinary bladder.
• A subsequent retrograde cystography confirmed the presence of a giant bladder stone.

Findings:

• The patient's history of lipomyelomeningocele and bladder augmentation enterocystoplasty is associated with the development of a giant bladder stone.
• Abnormal tracer distribution on Tc-DTPA renography indicated a potential issue within the bladder.
• Retrograde cystography definitively diagnosed the giant bladder stone.

Implications:

• This case underscores the importance of long-term monitoring for complications following bladder augmentation surgery in patients with neurogenic bladder.
• Giant bladder stones can form in augmented bladders, necessitating advanced diagnostic and potentially surgical interventions.
• Understanding these long-term sequelae is crucial for optimizing patient care and management strategies in pediatric urology and reconstructive surgery.