Obstructive uropathy from a giant urinary bladder stone: a rare urological emergency
Subhabrata Mukherjee1, Rajan Kumar Sinha2, Mussab Hamdoon3
1Department of Urology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
BMJ Case Reports
|January 20, 2021
Summary
A large bladder stone caused severe urinary issues and kidney damage in a 53-year-old man. Surgical removal of the stone resolved the kidney problems and improved urinary flow after treatment for bladder outlet obstruction.
Area of Science:
- Urology
- Nephrology
Background:
- Recurrent urinary tract infections and lower urinary tract symptoms can indicate underlying urological issues.
- Delayed diagnosis and treatment of bladder stones can lead to serious complications like hydronephrosis and renal impairment.
Observation:
- A 53-year-old male presented with a 3-year history of lower urinary tract symptoms and recurrent urinary tract infections.
- Physical examination revealed a pelvic mass, and blood tests showed elevated serum creatinine (2.9 mg/dL).
- Imaging confirmed a large bladder stone (9 cm×6 cm) causing bilateral hydroureteronephrosis.
Findings:
- Emergency open cystolithotomy successfully removed the large bladder stone.
- Post-operative recovery included complete resolution of hydronephrosis and normalization of renal function within 2 weeks.
- Uroflowmetry identified underlying bladder outlet obstruction, managed effectively with alpha-blocker therapy.
Implications:
- Prompt diagnosis and surgical intervention are crucial for managing large bladder stones and preventing irreversible kidney damage.
- Addressing associated bladder outlet obstruction is essential for long-term urinary symptom resolution and improved quality of life.
- This case highlights the importance of thorough investigation for persistent urinary symptoms to avoid severe urological complications.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
136
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
136
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
217
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
217
01:30Urinary Tract Calculi III: Medical Management
85
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
85
01:20Disorders of the Urinary System
797
The urinary system is responsible for eliminating waste and excess fluids from the body. However, disorders of the urinary system can arise due to various reasons like infections, stress, age, congenital abnormalities, and lifestyle.
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
797
01:28Urinary Tract Calculi V: Nursing Management
134
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
134
01:28Urinary Tract Calculi I: Introduction
227
Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
227