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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 5  |  Issue : 3  |  Page : 171-173

Giant vesical calculus in augmented bladder with mitrofanoff procedure


Department of Urology, GGMC and J.J. Hospital, Mumbai, Maharashtra, India

Date of Web Publication19-Oct-2015

Correspondence Address:
Dr. Venkat Arjunrao Gite
Department of Urology, GGMC and J.J. Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.167513

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  Abstract 

A 25-year-old male with a diagnosis of exstrophy epispadias complex underwent surgery at the age of 5 and 15 years. Last surgery done was augmentation cystoplasty with mitrofanoff procedure which eventually failed, and he presented with incontinence and dysuria. Ultrasonography and contrast-enhanced computerized tomography revealed multiple large stones; the largest was 7 cm in size. The patient underwent an open cystolithotomy for removal of the stones weighing 1.25 kg. Largest reported stone burden in an augmented bladder in the literature is 1.4 kg until now.

Keywords: Augmentation cystoplasty, cystolithotomy, vesical calculus


How to cite this article:
Gite VA, Siddiqui AK, Bote SM. Giant vesical calculus in augmented bladder with mitrofanoff procedure. Arch Int Surg 2015;5:171-3

How to cite this URL:
Gite VA, Siddiqui AK, Bote SM. Giant vesical calculus in augmented bladder with mitrofanoff procedure. Arch Int Surg [serial online] 2015 [cited 2024 Mar 29];5:171-3. Available from: https://www.archintsurg.org/text.asp?2015/5/3/171/167513


  Introduction Top


Urinary bladder calculi larger than 100 g are called giant vesical calculi. [1] It either comes from the upper tract or originates in the bladder due to infravesical obstruction. In the postaugmented bladder with a mitrofanoff procedure, if patients do not comply with regular self-intermittent catheterization, there is stagnation of urine and formation of the stone. We report a case of bladder stone weighing 1.25 kg that developed following augmentation cystoplasty with the mitrofanoff procedure.


  Case Report Top


A 25-year-old male presented with a history of two surgeries for exstrophy epispadias complex at the age of 5 and 15 years. Last surgery was an augmentation cystoplasty with bladder neck closure and mitrofanoff procedure using the appendix. He was apparently well 5-6 months after surgery but failed to perform self-catheterization as instructed. He thereafter developed incontinence and dysuria.

On examination, he had a closed appendiceal stoma with a cicatrized crippled site of previous surgery; along with epispadias and left complete indirect inguinal hernia with incontinence from the epispadiatic meatus.

His baseline biochemical investigations were normal. Hemoglobin - 14.7 g%, total leukocyte count - 7600/mm 3 , and serum creatinine - 1.4. Urine microscopy showed 5-6 pus cells, and urine culture was negative. On Ultrasonography and abdominopelvic contrast-enhanced computerized tomography, he was found to have a thickened bladder wall with multiple large vesical calculi. The largest measured 7 cm in its widest dimension [Figure 1]. Patient electively underwent cystolithotomy with suprapubic cystostomy (SPC) under general anesthesia. Four stones of average size >5 cm each were removed weighing 1.25 kg [Figure 2], [Figure 3], [Figure 4]. No obvious growth was found in the bladder [Figure 2] and [Figure 3]. The stones were sent for chemical analysis and found to be of struvite type. Postoperative period was uneventful. Stitches were removed on the 7 th postoperative day, and the patient was discharged home with the SPC.
Figure 1: Contrast-enhanced computerized tomography showing multiple stones in bladder

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Figure 2: Weighing machine showing stones >1.25kg

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Figure 3: Size of stones with scale

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Figure 4: Intraoperative photograph of stones in augmented bladder

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  Discussion Top


Bladder stones are usually small and come from the upper tract, but they may also form natively due to infravesical obstruction. [2] Due to persistent residual urine in bladder, there is concentration of calcium oxalate crystals which coalesce to form stones. Bladder stones vary in size. Small stones may pass spontaneously while large stones may require endoscopic or open surgery. The largest stone in the bladder was reported by Arthure in 1953 [3] and weighed 6294 g. It developed in a bladder diverticulum. Nowadays, with early diagnosis and treatment such large stones are rarely seen.

We report a case of the second largest size of bladder calculi (1.25 kg) which developed in an augmented bladder. Stone formation in an augmented cystoplasty bladder where the bowel is used for augmentation is late but common complication (40% incidence). [4] Bladder calculi are 5 times more common in augmented bladders in which the patient is on self-catheterization, [5] and in the mitrofanoff procedure, it is 10 times more common. [6]

Bladder calculi can be treated with transurethral or percutaneous cystolithotripsy. However, large and multiple stones with no urethral access as described in this report require open surgery. The patient had an open cystolithotomy with SPC and removal of 4 stones (each >5 cm) and weighing 1.25 kg. On chemical analysis, it was struvite type.


  Conclusion Top


Stone formation is the most common problem in augmented bladders and 10 times more common after a mitrofanoff procedure. [1] They are usually large, multiple, and require open surgery. Stone formation can be prevented by bladder wash and stringent follow-up. [1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kumar S, Jayant K. Massive vesical calculi formation as a complication of augmentation cystoplasty. Nephrourol Mon 2014;7:e22297.  Back to cited text no. 1
    
2.
Mckay HW, Baird HH, Lynch K Jr. Analysis of 200 cases of urinary calculi with particular reference to methods of management of ureteral stones. J Am Med Assoc 1948;137:225-9.  Back to cited text no. 2
[PUBMED]    
3.
Arthure H. A large abdominal calculus. J Obstet Gynecol 1953;60:416.  Back to cited text no. 3
    
4.
Austin JC. Long-term risks of bladder augmentation in pediatric patients. Curr Opin Urol 2008;18:408-12.  Back to cited text no. 4
    
5.
DeFoor W, Minevich E, Reeves D, Tackett L, Wacksman J, Sheldon C. Gastrocystoplasty: Long-term followup. J Urol 2003;170(4 Pt 2):1647-9.  Back to cited text no. 5
    
6.
Abdulmajed MI, Shergill IS. Giant bladder stone and a rare complication. Br J Hosp Med (Lond) 2012;73:713.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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