Diagnostic dilemma: Giant ‘stone’ in a man’s bladder looked like an ostrich egg
The patient: A 35-year-old man in Iran
The symptoms: The man visited a hospital urology clinic and described discomfort in his bladder. He had no problems with urination and no history of surgery or illness in this area of his body. He also did not present the typical symptoms of a urinary tract infectionsuch as feeling a constant need to urinate or having a burning sensation during urination.
What happened next: When doctors performed a physical examination of the man’s abdomen, they detected a large, smooth, solid mass above his pubis – the front of the pelvis where two pubic bones are connected by cartilage.
The dense mass was not attached to the pelvic area or abdominal wall, and an ultrasound revealed it to be an egg-shaped object about 4.3 inches (11 centimeters) in diameter, according to a report of this man’s case.
The diagnosis: Doctors at the hospital identified the mass as unusually large. bladder stone. Also known as calculationsthese objects develop when minerals in urine accumulate in the form of crystals; about 85% of their composition is calcium. They can form in the bladder when it does not empty completely, causing minerals in the urine to concentrate and crystallize.
Bladder stones usually form directly in the bladder, but they can sometimes arise from small kidney stones that migrate from the kidneys into the bladder or into the muscular tube between them, called the ureter.
Smaller bladder stones are invisible to the naked eye, but their size can vary greatly. Small stones generally go unnoticed and are passed during normal urination. However, larger stones can obstruct the flow of urine and irritate the walls of the urinary tract, causing pain, interrupted urination, or internal bleeding.
The treatment: After verifying that the egg-shaped stone was not obstructing or constricting any part of the patient’s urinary tract, doctors removed the stone surgically, in a procedure called cystolithotomy. The mass was so large that the incision had to be extended to the back of the bladder.
The extracted stone weighed 1.8 pounds (826 grams) and measured approximately 5 inches (13 cm) long, 4 inches (10 cm) wide, and 3 inches (8 cm) high.
Surgeons installed a catheter to help the man urinate while he healed, and removed it seven days after the operation.
What makes the case unique: Stones in the urinary tract are relatively commonbut bladder stones only represent around 5% cases, kidney stones being much more common. Giant stones that require surgical removal, like the one affecting the patient, “are very rare,” according to the case report.
Remarkably, this large stone is overshadowed by the current record holder for bladder stones: a mass weighing 4.2 pounds (1.9 kilograms) and measuring 7 inches (17.9 cm) long. In Brazil, doctors surgically removed a male patient’s stone in 2003.
Still, the large size of the bladder stone extracted from the Iranian man was highly unusual, the surgeons wrote. “Regarding the characteristics of the stone in our case, our report was the first in Iran and the world,” they said.
This article is for informational purposes only and is not intended to offer medical advice.
