Delivery of a massive urinary stone from an augmented bladder using obstetrical forceps

A 48-year-old man presented for evaluation of an expanding abdominal mass. Twenty years earlier, he had developed Fournier's gangrene requiring extensive debridement. He underwent augmentation cystoplasty with a catheterizable stoma due to a proximal urethral stricture. Fifteen years later, he was found to have a 14 cm x 18 cm bladder augment calculus. Simpson obstetric forceps were passed into the augment to deliver a 1110 gram stone with minimal devitalization of the colonic augmentation tissue. This is the first report of stone management with obstetric forceps in an augmented bladder. The specimen itself is among the largest stones ever reported.