Urinary bladder stones in women

Urethral Calculus as an Uncommon Cause of Acute Urinary Retention in Women Diagnosis and Management: A Case Report

Background

Urethral calculi causing acute urinary retention is a highly uncommon condition in women, which poses distinctive difficulties in diagnosis and treatment. This report presents the case of a 52-year-old woman who experienced acute urinary retention caused by a urethral stone. It emphasizes the effective use of minimally invasive methods and underscores the importance of comprehensive multidisciplinary treatment.

Case presentation

A 52-year-old woman patient arrived with acute urinary retention symptoms that lasted 6 hours. She complained of pain in the perineal and periurethral regions. She struggled with poorly managed type 2 diabetes, metabolic syndrome, and frequent cystitis. The examination showed the presence of a 2-cm stone in the urethra. The treatment utilised retrograde propulsion and laser fragmentation. Postoperative magnetic resonance imaging results were normal, and follow-up care involved managing diabetes and adopting lifestyle changes to prevent the recurrence of cystitis and stones for 6 months.

Conclusion

Urethral calculi exceptionally cause acute urinary retention in women. To achieve successful outcomes and prevent recurrence, it is crucial to prioritize prompt, minimally invasive treatment, and comprehensive management.

Big bladder stone accompanied by big posterior urethral stone: A management of rare case report

INTRODUCTION AND IMPORTANCE

Urinary tract stones are a common disease, but concurrent large-size stones in the bladder and urethra are rare. This phenomenon can lead to obstruction, infection, and other complications. We reported the management of a rare case of a giant bladder stone accompanied by a big posterior urethral stone.

CASE PRESENTATION

A 36-year-old man with a chief complaint of not being able to have spontaneous micturition, frequent expulsion of stones from the penis, and a history of hematuria. Bladder examination revealed a giant bladder stone of 1278 Hounsfield Unit (HU) with a size of 4.1 × 7.2 cm, and urethral examination revealed a stone of 1275 Hounsfield Unit (HU) with a length of 4.3 × 4.2 cm, without mass. This patient underwent vesicolithotomy and urethrotomy. The evaluation showed spontaneous micturition and dissolved hydronephrosis.

CLINICAL DISCUSSION

Urinary tract stone management primarily involves endourology or open surgery. For smaller stones (<5-6 mm), medication is sufficient, as they often pass spontaneously. Larger stones may require interventions like vesicolithotomy or urethrotomy. Vesicolithotomy is preferred for complex or large bladder stones, while urethrotomy is performed if the stone location is palpable or seen on imaging. These procedures are practical options for general surgeons in first-level hospitals.

CONCLUSION

Concurrent large bladder and urethral stones are uncommon. Endourology or open surgery is typically employed. Treatment selection should be personalized to individual patient assessment to mitigate potential complications effectively.

Expanding the limits of vaginal surgery: Transvaginal vesicolithotomy for an incarcerated procidentia: A case report and literature review

Bladder stones are rare in women. This report presents the case of a woman with a massive bladder stone and incarcerated procidentia. The 75-year-old woman presented to the outpatient clinic with procidentia and recurrent urinary tract infections. Preoperative imaging led to the diagnosis of cystolithiasis. After multidisciplinary counseling the patient underwent a vaginal hysterectomy with bilateral oophorectomy and transvaginal vesicolithotomy. A bladder biopsy was performed to rule out any malignancy. After three days, the patient was discharged with a Foley catheter; 15 days later, the bladder catheter was removed. She had an uncomplicated postoperative course. The presence of cystolithiasis and pelvic organ prolapse remains a challenge both in diagnosis and in treatment. The literature lacks solid evidence on the optimal management of these cases. Although there are no recommendations or consensus for their treatment, it seems that the one-step vaginal approach is preferable to the abdominal route.

Bladder Stone Formation due to Intravesical Migration of the Intrauterine Device: A Report of 2 Cases

INTRODUCTION

Approximately 5% of bladder stones occur in women and are usually associated with foreign bodies or urinary stasis. Spontaneous migration of the intrauterine device (IUD) into the bladder is a rare complication. In this report, we present 2 cases of migrated IUD who had undergone surgery at our clinic due to bladder stones.

CASE PRESENTATIONS

We detected migrated IUDs into the bladder in 2 female patients, aged 37 and 56 years, who presented with lower urinary tract symptoms and urinary tract infection. In the first case, endoscopic cystolithotripsy was performed, and the IUD was removed without complications. In the second case, the IUD could not be removed endoscopically since it had fractionally invaded the bladder wall, and the IUD was removed without complications by performing an open cystolithotomy.

CONCLUSION

A comprehensive gynecological history should be taken from every female patient presenting with recurrent urinary tract infections and lower urinary tract symptoms. If these patients have a history of IUD placement, the possibility of the intravesical migration of this device should be kept in mind.

Differential diagnosis of a calcified object from the South Tombs Cemetery at Amarna, Egypt

OBJECTIVE

This paper provides a brief history of the publication of calcified biological objects and presents one that was present in the grave associated with a mature adult female buried in the South Tombs Cemetery at Amarna, Egypt (c. 1353-1332BCE).

METHODS

Macroscopic examination revealed an ovoid object constructed of concentric layers of a coarse sand-like material oriented around a dense core that lacked evidence of parasites. Microscopic examination revealed the object is composed of densely, yet haphazardly packed, elongated octahedron shaped crystals with no evidence of cellular structures. Basic chemical analysis eliminated calcium carbonate as a constituent material.

RESULTS

Based on comparison with previously published examples from the archaeological and clinical literature and careful differential diagnosis, it is suggested this object is a bladder stone.

SIGNIFICANCE

A brief discussion of the implications of bladder stones on individual health and broader epidemiological constraints to illustrate the depth such discoveries can bring to our understanding of ancient lived experience concludes the work.

LIMITATIONS

The burial of Ind. 286 was disturbed. The identification of a bladder stone presumes the stone would have been found within the pelvic cavity, which cannot be confirmed. Other graves in the vicinity of this grave were also disturbed. It is unlikely, but still possible, that the stone originated from another grave and was relocated to this grave after disturbance. Full chemical analysis was not possible.

SUGGESTIONS FOR FUTURE RESEARCH

Radiographic and chemical analysis would provide more information to strengthen the certainty of the differential diagnosis.

Vesical Calculi and Female Pelvic Organ Prolapse: A Case Report and Literature Review

This study presents a case report and reviews the literature on the simultaneous occurrence of advanced uterovaginal prolapse and urolithiasis, aiming to provide a comprehensive analysis of the reported cases. A thorough search was conducted in PubMed and Google Scholar; the search strategy included specific keywords and terms related to both conditions aiming to identify relevant case reports describing the association between advanced uterovaginal prolapse and urolithiasis; a total of 22 case reports were found in English literature. We present a case report of a 56-year-old woman, para 4, presenting with complaints of vaginal bulge and urinary symptoms. Upon examination, a complete procidentia with superficial ulceration was observed. During the reduction of the uterus, multiple small stones were noted coming through the urethral meatus. The patient underwent a vaginal hysterectomy, and the bladder stone was successfully extracted through vaginal cystotomy without complications. Our case report highlights the association between vesical calculi and female high-grade pelvic organ prolapse. Managing bladder stones in the context of pelvic organ prolapse can be challenging and vary significantly, reflecting the individual patient characteristics and surgeon preferences. The lack of standardized guidelines for managing bladder stones in the presence of pelvic organ prolapse highlights the need for further research.

The Clinical Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy in the Treatment of Patients with Urinary Calculi

Objective

To evaluate the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) for urinary calculi and precautions of postoperative complications.

Methods

90 patients with urinary calculi at our hospital were randomly recruited between July 2019 and July 2020 and were allocated (1 : 1) to receive either ESWL (observation group) or conventional surgery (control group). Clinical efficacy was the primary endpoint, whereas adverse events were the secondary endpoint.

Results

The operation time, early activity time, and hospitalization time of the observation group were significantly lower than those of the control group (P < 0.05). ESWL resulted in less postoperative pain in patients versus conventional surgery (P < 0.05). ESWL was associated with a significantly higher total clinical efficacy (97.78%) versus conventional surgery (82.22%) (P < 0.05). The eligible patients given ESWL had a lower incidence of complications (11.12%) versus those given conventional surgery (31.12%) (P < 0.05).

Conclusion

Hematuria prevention requires precise localization of stones as well as adjustment of pulse energy and the number of impacts due to stone changes. Precautions against renal colic necessitate complete comminution of stones intraoperatively, more postoperative water intake, moderate exercise, or injection of antispasmodic drugs and cathartics for pain relief. Nausea and vomiting precautions require preoperative recording of previous medical history and corresponding treatment, intraoperative real-time adjustment of voltage pulse frequency, and duration depending on the magnitude of intraoperative reaction. Urinary tract infection prevention requires preoperative prevention and proper postoperative anti-infection and anti-inflammatory treatment, along with enough water intake and bed rest. Other precautions include thorough comminution of the calculi, proper anti-infection and anti-inflammatory treatment, no early exercise or excessive activity after surgery, and proper postoperative care. ESWL is effective in treating patients with urinary calculi with a simple, safe, and quick operation and a low incidence of adverse events, as it effectively reduces the incidence of complications, accelerates the recovery of patients and improves their quality of life.

A Rare Case Report of Giant Urinary Bladder Stone Causing Recurrent Dysuria in a Woman

Background

Large urinary bladder stones are not common and even less common in females. We report a case of large bladder stone presented with acute retention of urine in a female patient. Case Report. A 62-year-old female presented in emergency department with retention of urine for 12 hours with history of recurrent UTIs for last 1 year. She was also complaining of mild dull lower abdominal pain for last 6 months. She had no history of incontinence of urine and fever. On physical examination, hard mass was palpable on suprapubic region on palpation of abdomen. Urine culture shows Escherichia coli for which antibiotics was given. An X-ray kidney ureter bladder showed a radio-opacity in the pelvic region measuring 9 × 8 cm in size. Ultrasonography revealed bilateral mild hydronephrosis with a large bladder stone. Open cystolithotomy was performed, and the stone was taken out. Stone biochemical analysis showed predominantly urate crystals. Patient had uneventful postoperative course, and she was discharged on 4^th postoperative day and was followed up for 1 months after operation.

Conclusions

Large urinary bladder stones are not common and even less common in females. Clinician should have think regarding large bladder stone as a cause of recurrent lower urinary tract symptoms like dysuria and should assess renal function for proper treatment. Open cystolithotomy is choice of operation in large bladder stone.

Consumption of soft drinks rich in phosphoric acid versus struvite crystallization from artificial urine

In recent years, there has been a continuous increase in the incidence of urolithiasis, especially in highly developed countries. Therefore, the question arises which factors specific to these countries may be responsible for the increase in the incidence of this disease. In this article, we try to assess the effect of phosphoric acid, a component of various carbonated drinks, including Coca-Cola, on the nucleation and growth of struvite crystals, which are the main component of infectious urinary stones. The research was carried out in the environment of artificial urine with and without the presence of Proteus mirabilis bacteria. In the latter case, the activity of bacterial urease was simulated by adding an aqueous ammonia solution. The obtained results indicate that phosphoric acid present in artificial urine causes the nucleation of struvite to shift towards a lower pH, which means that struvite nucleates earlier in artificial urine compared to the control test. The amount of struvite formed is the greater the higher the concentration of phosphoric acid. At the same time, as the concentration of phosphoric acid increases, the growing struvite crystals are larger, which is disadvantageous because they are more difficult to remove from the urinary tract along with the urine. For the highest levels of phosphoric acid tested, large dendrites are formed, which are particularly undesirable as they can damage the epithelium of the urinary tract. The effect of phosphoric acid on the nucleation and growth of struvite is explained in base of chemical speciation analysis. This analysis indicates that the MgHCit and MgCit^- complexes have the main influence on the nucleation and growth of struvite in artificial urine in the presence of phosphoric acid. It should be keep in mind that all these effects of phosphoric acid are possible when the urinary tract is infected with urease-positive bacteria. In the absence of infection, phosphoric acid will not cause struvite to crystallize.

Application of Percutaneous Holmium Laser Lithotripsy in the Treatment of Bladder Calculi with Lower Urinary Tract Obstruction or Pelvic Joint Disease

OBJECTIVE

The aim was to summarize the experience of percutaneous holmium laser lithotripsy in the treatment of bladder calculi with lower urinary tract obstruction or pelvic joint disease in our hospital, explore its efficacy and safety, and improve the minimally invasive surgical technique for bladder calculi.

METHODS

The clinical data of 61 patients with bladder calculi combined with lower urinary tract obstructive diseases, including urethral stricture, benign prostatic hyperplasia, and bladder neck contracture or pelvic joint diseases in our hospital from 2017 to 2019 were retrospectively analyzed. All patients with bladder stones measuring 1.5-9 cm were placed in supine or lithotomy position. B-scan was conducted to locate the puncture above the pubic symphysis, establishing a 16-30 Fr bladder channel, and Lumenis holmium laser lithotripsy was subsequently performed through a Li Xun Nephroscope. The crushed stones were flushed out through the percutaneous bladder channel or taken out with foreign body forceps. After surgery, the cystostomy tube was indwelled for 3 days.

RESULTS

All the 61 cases were operated successfully with an average lithotripsy time of 25 min, and there was no conversion to open surgery. Postoperative reexamination showed neither residual calculi nor complications such as severe infection, massive hemorrhage, and intestinal injury.

CONCLUSION

Percutaneous holmium laser lithotripsy is an improved minimally invasive surgical technique for the treatment of bladder calculi with the advantages of clear surgical field, high stone removal efficiency, less trauma, low-pressure bladder perfusion, and low incidence of accessory injury and infection. For patients with lower urinary tract obstructive disease resulting in obstruction of transurethral surgery and patients with pelvic joint disease resulting in difficult lithotomy position placement, this procedure is more advantageous than transurethral surgery. It is also suitable for bladder calculus with a long diameter >5 cm or multiple calculi.

Management of a Massive Bladder Stone Burden in an Elderly Comorbid Woman via a Transurethral Approach

Here we present the case of a 78-year-old medically comorbid woman with an extremely large bladder stone burden treated by cystolithalopaxy performed using a Swiss LithoClast^® Trilogy Lithotripter (Boston Scientific, Marlborough, MA, USA) through a nephroscope traversing a transurethral Amplatz sheath.

A Mislocated Intrauterine Device Migrating to the Urinary Bladder: An Uncommon Complication Leading to Stone Formation

Intrauterine devices are a popular form of reversible contraception among women. Its administration can lead to some uncommon but serious complications such as perforation leading to its migration into adjacent organs. Like any foreign body, the presence of an IUD in the bladder can result in stone formation due to its lithogenic potential. We report a case of an IUD migrating from its normal position in the uterine cavity into the urinary bladder causing chronic low urinary tract symptoms in a 43-year-old female patient. The device was securely removed without complications using grasping forceps under cystoscopy, and no parietal defect was detected. A mislocated IUD is a rare complication that should be considered in female patients presenting with chronic urinary symptoms.

Cystolitholapaxy and laparoscopic sacrocolpopexy in a case of multiple urinary bladder calculi & vault prolapse

Vesical calculi are more common in men than women. The prevalence in women is less than 2%. Multiple vesical calculi in chronic cases of utero vaginal prolapse or vault prolapse is rare. Urinary stasis, urethral kinking along with chronic infection are the probable predisposing factors for stone formation [2]. We report a case of 65 year old female, with mass per vagina since 10 years, who developed acute urinary retention due to impaction of vesical calculus at the external urethra meatus. Subsequently in a span of 12 h she passed 3 more vesical calculi. KUB X-ray failed to show any calculi but Computed Tomography(CT) Kidney Ureter Bladder (KUB) showed 2 vesical calculi. After cystolitholapaxy she underwent laparoscopic sacrocolpopexy for vault prolapse. In cases of chronic uterovaginal prolapse or vault prolapse X-Ray KUB should not miss the prolapsed part of the cystocele as calculi are present in the most redundant part. Chances of missing radiolucent uric acid calculi is high. In such cases CT KUB is essential.

An Uncommon Cause of Dysuria in a Female Patient: Huge Urinary Bladder Stones

The urinary bladder stones are formed due to urinary retention, obstruction to the flow of urine commonly caused by enlargement of the prostate in males, urinary tract infections, and foreign body. The urinary bladder stones are usually found in males, and its presentation in females is a rare entity. Recurrence of urinary tract stones is commonly due to either repeated urinary tract infections or any metabolic condition. We present a case of a 75-year-old female patient who had a history of urinary tract infection and bladder stone formation and was operated for the 16th time recently for removal of her bladder stones.

Transurethral cystolitholapaxy with the AH-1 stone removal system for the treatment of bladder stones of variable size

Background

The treatment of large volume bladder stones by current equipments continues to be a management problem in both developing and developed countries. AH-1 Stone Removal System (SRS) invented by us is primarily used to crush and retrieve bladder stones. This study evaluated the safety and efficiency of transurethral cystolitholapaxy with SRS for the treatment of bladder stones of variable size.

Methods

SRS, which was invented by Aihua Li in 2007, composed by endoscope, continuous-flow component, a jaw for stone handling and retrieving, lithotripsy tube, handle, inner sheath and outer sheath. 112 patients with bladder stones were performed by transurethral cystolitholapaxy with SRS since 2008. We compare the surgical outcome to bladder stones of variable size, and evaluate the surgical efficiency and safety.

Results

Characteristics of patients and stone removal time in variable size were evaluated. To patients with single stone, stone size was 1.35 ± 0.37 cm and the operating time was 5.50 ± 3.92 min in Group A. Stone size was 2.38 ± 0.32 cm and the operating time was 11.90 ± 9.91 min in Group B. Stone size was 3.30 ± 0.29 cm and the operating time was 21.92 ± 9.44 min in Group C. Stone size was 4.69 ± 0.86 cm and the operating time was 49.29 ± 30.47 min in Group D. The difference was statistically significant between the four groups. Among them, 74 (66.07%) patients accompanied with benign prostatic hyperplasia (BPH) were treated by transurethral resection of the prostate (TURP) simultaneously. Compared between the four groups, the difference of the TURP time was not statistically significant, P >0.05. No significant complication was found in the surgical procedure.

Conclusions

Transurethral cystolitholapaxy with SRS appears to be increased rapidity of the procedure with decreased morbidity. It is a safe and efficient surgical management to bladder stones. This endoscopic surgery best fits the ethics principle of no injury; meanwhile, the accompanied BPH could be effectively treated by TURP simultaneously.

The twin amplatz sheath method: a modified technique of percutaneous cystolithotripsy for large bladder stones in female patients

To minimize the operative time and to avoid open cystolithotomy in women with large bladder stone (>5 cm), we present here a modification of percutaneous cystolithotomy, a well-described standard procedure for urinary bladder stones. With this technique, suprapubic percutaneous access was achieved under cystoscopic guidance. The suprapubic tract was dilated and an Amplatz sheath of 30 Fr was placed. Simultaneously, the urethra was sequentially dilated with fascial dilators and a 28 Fr Amplatz sheath was guided into the bladder and the foot end of the table lowered to 20° to facilitate high-speed outflow of irrigant and stone particles. A 26.5 Fr nephroscope was passed through the suprapubic Amplatz sheath and the stone was fragmented by intracorporeal pneumatic device keeping the stone close to the proximal end of the urethral Amplatz. These maneuvers help in washing out stone fragments periurethrally and keeping the endoscopic vision clear while breaking the stone.

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

A 27-year-old woman presented with a history of recurrent urinary tract infections in infancy and urinary incontinence secondary to lipomyelomeningocele. At the age of 7, she underwent bladder augmentation enterocystoplasty, requiring intermittent catheterization without urinary tract infections until present. A Tc-DTPA renography was performed to evaluate renal function, in which an abnormal tracer distribution was seen in urinary bladder, and furthermore, a retrograde cystography shows a giant bladder stone.

Neuromodulation for overactive bladder

Overactive bladder (OAB) affects millions of people worldwide yet first-line treatments are often poorly tolerated and compliance rates are low. Neuromodulation works via afferent nerve modulation and offers a minimally invasive and reversible alternative treatment option for patients with OAB who have failed first-line therapy. Neuromodulation has revolutionized the management of OAB and is now well established as a safe and effective treatment for those refractory to conservative treatments. Multiple neuroanatomical pathways have been described for sacral neuromodulation including the S3 nerve root, pudendal nerve and tibial nerve. The S3 nerve root is currently the main treatment target and has the most long-term data on safety and efficacy to support its use. However, studies on neuromodulation at the pudendal nerve or posterior tibial nerve have been positive and their role in treatment continues to evolve. Most urologists who are experienced in voiding dysfunction can become proficient in each technique. Patient selection, surgical techniques and postoperative management differ slightly between approaches and urologists should familiarize themselves with these differences. Treatment of OAB should progress from the least to most invasive modality, and neuromodulation provides an attractive option owing to its minimally invasive approach, tolerability, positive outcomes and reversibility.