Authors: Eeshansh Khare , Avani Shrivastava

Abstract

Background: Large urinary bladder (UB) calculus is now rare in urological clinical practice. UB stone presents with obstructed urinary flow, increased urinary frequency, and lower abdominal and perineal or penile pain. Male patients are affected more. Hot environmental condition, poor water intake, benign prostatic enlargement, urethral stricture, and prolonged urethral catheterization are some of the contributory factors for bladder stone formation. Herein, we have tried to highlight importance and need of open cystolithotomy in five cases of large UB calculus presented to outpatient department (OPD) with their clinical presentation, history, and investigations with probable causes and review of literature.
Case series: Five consecutive patients were evaluated, diagnosed, and operated for giant UB calculus by open cystolithotomy. Patients were discharged with suprapubic catheter (SPC) and per-urethral catheter (PUC) in situ. SPC and PUC were sequentially removed after 3 weeks of surgery. All five patients had intact UB stone removal except one where pneumatic lithotripter was used in open approach. Post-operative period of all patients was uneventful. None of the patients had any postoperative complications. Average hospital stay was 4–5 days. Visual Prostate Symptom Score (VPSS) decreased and maximum flow rate (Qmax) improved in all patients.
Conclusion: Poor health care awareness, poor socio-economic status, and faith in alternative medicine may be the causal factor behind delayed clinical presentation of large UB stones. Despite huge advances in endourology, need of open surgical approach like cystolithotomy is still there. New generation of urologists must be well versed with open approach also, as few clinical case require open approach only. 

Keywords: Urinary bladder, calculus, LUTS.