Giant bladder stone with squamous cell carcinoma of bladder: Case report and the literature review

Complicated Case of a Giant Bladder Stone and Forgotten Double-J (DJ) Stent in an Otherwise Healthy Elderly Patient: A Case Report

Giant bladder stones, defined as stones weighing over 100 g and/or measuring more than 4 cm in diameter, are relatively uncommon compared to other types of urinary tract stones. This patient, an 85-year-old male with an unknown medical history, initially presented with urinary incontinence and hematuria. Radiological findings revealed a large prostate, a forgotten left renal double-J (DJ) stent for more than 20 years with an encrusted bladder stone, and additional calculi in the lower pole of the left kidney. The patient underwent laser cystolithotripsy, but due to the complexity of the case, a second procedure was scheduled. Following the second procedure, the patient experienced a generalized tonic-clonic seizure and subsequent loss of consciousness, which was attributed to hyponatremia. The patient received appropriate management to correct hyponatremia and antiepileptic medication to control the seizure. The patient's condition eventually improved and he was discharged home with prescribed medications and follow-up appointments. This case emphasizes the potential complications of giant bladder stones and a forgotten DJ stent in an 85-year-old male patient as a rare consequence following such a rare presentation.

Giant bladder calculi due to four years neglected cystostomy

Giant bladder calculi are rare and long-term usage of cystostomy could cause stone formation. Due to the lack of evidence on giant bladder calculi and the long-term usage of cystostomy can cause bladder calculi formation, we provide a case study of a man with a neglected cystostomy with giant bladder calculi for 4 years. A fixed mass was discovered in the suprapubic region. Ultrasound examination revealed 4.1 × 5.5 cm bladder calculi and contracted left kidney. Bipolar voiding cystourethrography portrayed stricture in pars pendular and membranacea, uneven bladder wall, and 4.5 × 4.5 cm bladder calculi. The stone was extracted, and the bladder filling test revealed a small bladder capacity. Since the patient refused urethral reconstruction and bladder augmentation, he was discharged with another cystostomy catheter. Six-month follow-up revealed no forming stones. Neglected cystostomy catheter can cause giant bladder calculi. Prompt diagnosis and treatment should be made to manage this condition to reduce the likelihood of bladder cancer.

Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study

BACKGROUND

Giant stones of the urinary bladder (GSBs) are rare and usually presented as case reports. We aimed to assess the clinical and surgical characteristics of GSBs and identify their predictors.

METHODS

A retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients' demographics, clinical presentations, and surgical peculiarities were studied.

RESULTS

Older age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa.

CONCLUSIONS

Solitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.

Giant bladder stone a rare cause of renal failure, a case report

INTRODUCTION AND IMPORTANCE

Bladder stones constitute approximately 5 % of all urinary tract stones. A giant bladder stone weighing >100 g and a diameter of >4 cm is a rare finding. Bladder stones are more common in adult males. Giant bladder stones are a rare entity in western practice, and are usually associated with bladder outlet obstruction, urinary tract infections, or the presence of intravesical foreign bodies and are rarely associated with renal failure.

CASE PRESENTATION

A 25-year-old Ethiopian male patient presented with facial puffiness of two weeks duration which worsened early in the morning. He had a history of recurrent suprapubic pain, and straining during urination. On examination, he had a tender suprapubic mass. Investigations showed bilateral hydronephrosis and renal failure. Subsequently, the patient was diagnosed with a huge bladder stone with acute renal failure. Later, the stone was surgically removed and the patient was discharged improved.

CLINICAL DISCUSSION

Risk factors for the development of bladder stones consist of bladder outlet obstruction, neurogenic bladder, chronic bacteriuria, presence of intravesical foreign substances, bladder diverticula, and rarely, upper urinary tract stone. Recurrent urinary tract infections, urinary retention, and hematuria are common signs of this disorder and rarely cause a renal failure like our patient.

CONCLUSION

A giant bladder stone is a rare disease in modern urology clinical practice. Despite its rarity, giant bladder stone can cause acute renal failure and needs more attention. A comprehensive clinical assessment and thorough investigation are required during the evaluation of this kind of patient to prevent misdiagnosis and to ensure prompt treatment.

Adenocarcinoma of Urinary Bladder With Distant Metastasis: Huge Fungating Tumor Eroding and Ripping-Off Through Suprapubic Region: A Rare Presentation

Adenocarcinoma of the urinary bladder is an extremely rare entity. It has aggressive behavior and it responds poorly to chemotherapy and radiotherapy. Painless hematuria and passage of clots are mainly common symptoms. Primary bladder adenocarcinoma has a poor prognosis due to its late presentation at an advanced stage. We present here, a rare case report of a 65-year-old male who presented with a huge ulcerative fungating tumor of clinical size 7 x 6 x 5 cm and radiological size 8.6 x 8.1 x 8 cm (exophytic component) and 3.6 x 3.3 x 3 cm (endophytic component) at suprapubic region eroding through pubic bone, rectus muscle and skin with features of lung and inguinal nodes metastasis. Wedge biopsy from fungating growth was suggestive of adenocarcinoma of the urinary bladder of papillary mucin secreting subtype which is also a very rare variant and subtype to get reported. It has a very poor prognosis and only a 6% of survival rate. Keeping all this context, due to poor Eastern Cooperative Oncology Group (ECOG) performance status, huge tumor burden, and advanced presentation of disease, it was suggested by the institutional tumor board, to provide him with the best palliative care management.

Coincidental finding of a giant bladder calculus and squamous cell carcinoma of bladder: A case report

Chronic irritation of bladder by urinary bladder calculus is a known risk factor for bladder cancer. The use of Wrigley’s obstetrical forceps in general surgical practice is a rare event. Herein, we report a case of a giant urinary bladder calculus which was removed by Wrigley’s obstetrical forceps during open cystolithotomy. The bladder biopsy showed squamous cell carcinoma of the bladder. With this report, we aim to create an awareness among surgeons about the role of the Wrigley’s obstetrical forceps during open cystolithotomy, and the role of taking urinary bladder biopsy from chronically inflamed/unhealthy sites.

Squamous cell carcinoma arising in an epidermal cyst of urinary bladder associated with vesicolithiasis: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Epidermal cysts can rarely occur in internal organs, but epidermal cyst of the urinary bladder is extremely rare with a very low tendency for malignant transformation. This article will guide the physicians to be aware of such rare complex neoplastic combinations to take proper decisions in management and treatment of the patients.

CASE PRESENTATION

A 40-year-old rural male patient with hematuria and urinary frequency presented to a hospital. Ultrasonography reported a cyst and a 2 × 1.5 cm stone in the urinary bladder. Surgery planned to remove the cyst and the stone. During the surgery, a cyst with solid parts and a stone were observed. The cyst had superficial penetrations into the bladder wall, the patient refused to done radical cystectomy, therefore the cyst excised from the bladder and sent for histopathological examination. The histopathological examination confirmed a well differentiated invasive squamous cell carcinoma arising from epidermal cyst with detrusor muscle invasion, staged pT2aNx. After diagnosis the patient received chemotherapy and improved his urinary symptoms. The possibility of further radical cystectomy and radiotherapy in neighboring countries remains open.

CLINICAL DISCUSSION

Urinary bladder cysts associated with stones are uncommon but the occurrence of epidermal cyst in the urinary bladder is an extremely unusual incidence and malignant transformation of this lesion made it even rarer.

CONCLUSION

Despite the rarity of malignant transformation in epidermal cyst and the unknown etiology of its occurrence in the urinary bladder, further clinicopathological and molecular studies are needed to reveal the possible pathogenesis with involved risk factors.