Giant vesical calculus associated with migrant IUCD: a case report

Background Intrauterine copper devices are a popular type of contraceptives, being in use for a long time. Migration of IUCD into the bladder is one of the many side effects of this contraceptive measure. Though a rare phenomenon, IUCD acting as a foreign body can cause stone formation in the bladder. Case presentation We present a 42-year-old female patient who presented with increased urinary frequency, dysuria, and suprapubic pain. Examination showed mild tenderness in the suprapubic region. On X-ray pelvis, she was found to have a giant stone covering IUCD in the bladder. She ultimately underwent cystolithotomy, and her IUCD with stone was removed. Consequently, she was discharged on the 4th postoperative day with a satisfactory condition. Conclusion Vesical calculus can form following migration of IUCD in the bladder. This article highlights the importance of careful insertion and follow-up investigation of IUCD. Radiological modalities like X-rays pelvis provide excellent visualization of the IUCD and can be used to confirm the accurate location of the contraceptive device.

Unani management of vesical calculus: a case report

Vesical calculus (Hisat-e-Masanah) accounts approximately 5% of all urinary tract stones. It has bimodal peaks age of incidence at 3 years in children in developing countries, and 60 years in adulthood. Despite advance technology of lithotripsy, the management of vesical calculus in children remains a challenge due to difficulty in passing of stone fragments and adverse effect of surgery. Hence alternative and safe treatment like Unani system of medicine can be adopted to avoid surgical procedure. The present paper deals with a case study in which a 10 years old male child patient suffered from a single vesical calculus was treated with Unani pharmacopeial medicine; Qurs Kaknaj (2 tablets), Qurs Kushta Hajrul Yahood (1 tablet) and Sharbat Buzoori Motadil (10 ml syrup) twice a day as oral administration, with the aim to evaluate the efficacy of drugs and to avoid surgery. Patient has shown excellent and significant result as 8×5 mm size of a stone flushed out at 3rd day of treatment without any operation.

Giant Mixed Vesical Calculus in a Patient in North Central, Nigeria: A Case Report

A 30-year old male Business man presented at the accident and emergency unit of Abnira Medical Centre in Jos city on account of inability to pass urine for over fifteen hours. There was concomitant excruciating lower abdominal pain and swelling that is tender to touch. A positive history of generalized weakness, fatigue, nausea, heamaturia was given. However, no fever, vomiting, headache nor history of fainting attacks. On examination, he was afebrile, acyanosed with associated tachycardia (pulse rate 121bpm) and tachypnea (respiratory rate of 27c/min).He was oriented in place, person and time with no focal neurological deficit. There were no cardiac and other respiratory signs picked on examination. His abdomen was soft and non-tender, with normal bowel sounds. However, there was renal angle tenderness. Biochemical investigations done on presentation showed normal sodium, potassium, chlorite, and bicarbonate. He has some evidence of dehydration and pre-renal azotemia (increased creatinine, urea and uric acid).His liver function tests, lipase, thyroid function test, phosphate, magnesium and albumin-corrected calcium were all normal.

Frequency of Metabolic Abnormalities of Vesical Calculus in Children Younger than 10 Yrs of Age

Aim: To assess the metabolic abnormalities in children younger than 10 years of age with vesical calculus. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Hospital, Khairpur from 1st October 2014 to 30th September 2016. Methodology: Two hundred and six children age <10 years of age and either gender presented with vesical calculus were enrolled. Demographic information like age, gender, residence, serum electrolytes, calcium, magnesium, phosphate, uric acid, blood, and urine pH were recorded for the purpose of metabolic workup. Results: The mean age was 4.76±1.22 years and 157 (76.2%) were males and 49 (23.8%) were females. The frequency of metabolic abnormalities was observed in 153 (74.3%) of the patients. A significantly higher prevalence of metabolic abnormalities was observed with male gender (p-value 0.006), dark colored urine as presenting symptoms (p-value 0.022), frequent urination (p-value 0.045), and hematuria (p-value 0.016). Of 153 patients with metabolic abnormalities, hypercalciuria was observed in 45 (29.4%), hypocitraturia in 73 (47.7%), hyperoxaluria in 21 (13.7%), and hyperuricosuria in 14 (9.2%) patients. Conclusion: The frequency of metabolic abnormalities was high among children with vesical calculus. Moreover, hypocitraturia in these children was observed in majority followed by hypercalciuria, hyperoxaluria, and hyperuricosuria. Keywords: Metabolic abnormalities, Children, Vesical calculus

Obstructive Urethrolithiasis in a Mule

Background: Obstructive urolithiasis is a rare but potentially serious condition in equids. In the reviewed literature, there are several case reports of urolithiasis in horses and donkeys, but the only mention of this condition in mules occurred as incidental findings at a slaughterhouse. Therefore, this work aims to describe the first report and successful treatment of obstructive urethrolithiasis in a mule (Equus asinus x Equus caballus). Case: A 10-year-old castrated male mule weighing 380 kg was referred for hospital care. Tachycardia (64 beats per min), mild dehydration (7%), increased capillary filling time (3 s), slightly congested mucous membranes, and dysuria were observed. During its attempts to urinate, the mule was able to expose the penis, resulting in only dribbling of urine with reddish coloration. Urethral catheterization failed to reach the urinary bladder and revealed an obstruction at the ischial arch (7 x 4 cm), as confirmed by palpation and ultrasonography. Additionally, rectal ultrasound examination showed urine sedimentation and a single 2.36 mm vesical calculus. After sedation, local anesthesia, and surgical preparation, urethrotomy in the standing position was performed over the urethral obstruction at the ischial arch, reaching the urethrolith that fragmented during removal. Urethral catheterization from the urethrotomy site to flush the urinary bladder and urethra were performed, but the remaining vesical calculus was not retrieved. Considering the presence of a vesical calculus, severe urethral damage caused by the spiculated calculus and catheterization attempts, permanent perineal urethrostomy was performed. Laboratory tests revealed unremarkable hematological parameters, while serum biochemistry showed increased creatinine level. Urinalysis revealed cloudiness, amber appearance, countless red blood cells and bacteria, and calcium carbonate crystals. The urethrolith composition included ammonia, carbonate, and oxalate. Twelve months after surgery, the mule was healthy, the urethrostomy was viable, and no complications were recorded during this period.Discussion: Although uncommon, there are reports describing calculi of different sizes and weighing up to 803 g, causing mild to severe clinical signs according to the degree of obstruction in horses and donkeys. In the mule described here, the urethrolith did not completely obstruct the urethra, but the spiculated calculus caused dysuria and hematuria. In fact, most animals are usually referred for acute abdominal signs or hematuria and pollakiuria, but other unusual signs, such as rectal prolapse, may also be present. In the present report, the diagnosis of obstructive urethrolithiasis was established based on clinical signs and transcutaneous ultrasound of the subischial area, allowing visualization of the urethrolith. To the best of our knowledge, this is the first report of obstructive urethrolithiasis affecting a mule in Brazil. We reiterate that this condition must be included in the differential diagnosis of mules and hinnies with hematuria and dysuria, especially when associated with abdominal pain. Additionally, urethrostomy associated with urethrotomy performed on this mule in the standing position was a low-cost procedure with good results. Due to the lack of specificity regarding the food management of the mule on the previous farm, an assessment cannot be made regarding the effects of its food on urolith composition.

A STUDY TO FIND THE PROPORTION OF VESICAL CALCULUS IN PATIENTS WITH BENIGN HYPERPLASIA OF PROSTATE

Vesical Calculus accounts for 5% of all types of urolithiasis. They are formed secondarily mainly due to benign hyperplasia of prostate. The aim of this study was to nd the proportion of patients with vesical calculus among patients with benign hyperplasia of prostate. This study was done in a tertiary referral centre for a period of one year. Atotal of 900 patients participated in this study and in them 87 (9.67%) patients had vesical calculus.

Giant Bladder Calculus in an Adult- A Persistent Problem in the Developing World: A Case Report

Introduction: Giant urinary bladder calculus in an adult is an uncommon entity. The number of patients with giant bladder calculi has decreased over recent years owing to wider availability of healthcare and better diagnostic modalities. Case Report: We present a case of a young adult without any history of recurrent urinary tract infections or bladder outlet obstruction with giant vesical calculus who presented to the emergency department with gross hematuria, abdominal pain, and dysuria. Investigations revealed a large calculus in the urinary bladder, and suprapubic cystolithotomy was performed. A large stone of 6.5×6×5.5 centimeters, weighing 125 grams, was removed. On follow-up, the patient was free of any symptoms and cystoscopy was normal. Conclusion: Urinary outflow obstruction must be ruled out in all patients with giant vesical calculus. Patients without any predisposing condition should be treated as a separate entity and evaluated accordingly. Multiple surgical treatment modalities are available for bladder calculus patients. Treatment is personalised as per size of stone, number of stones, and associated comorbidities.

A Turn for the Better – The Benefit of Doing A Limited Prone Rescan to Confirm the Exact Location of an Equivocal Vesicoureteric Junction Calculus Detected on Supine Abdominopelvic CT Scan

Background: In this case report, a calculus was seen at the vesicoureteric junction (VUJ) on computed tomography (CT), in an equivocal location. The subsequent urological management is based on the precise location of the calculus (ureteric orifice at the VUJ versus urinary bladder lumen). A simple manoeuvre of doing a limited prone CT rescan of the urinary bladder confirmed the location of the calculus within the urinary bladder, thus allowing conservative management. Case Presentation: A middle-aged male with known urolithiasis presented with right sided abdominal pain, nausea and vomiting. Differentials included a right ureteric calculus and appendicitis. A CT scan of the abdomen and pelvis in the supine position revealed a 0.4 cm calculus at the right VUJ with mild right hydronephrosis. It was not certain whether this calculus was impacted at the VUJ or within the bladder lumen. A limited prone CT re-scan of the pelvis was performed, which confirmed that the calculus was within the urinary bladder, as it migrated to a dependent position in the lumen of the bladder when in the prone position. Patient was managed conservatively and passed the calculus via the urethra the next day. Conclusion: Prone CT is the gold standard for the evaluation of stone disease and can differentiate a vesical calculus from a vesicoureteric junction calculus. In cases where a supine abdominopelvic CT is performed (e.g. in institutions which do not routinely scan in prone position or in cases where a supine scan is done to exclude other pathologies), an additional limited prone CT is needed in equivocal cases for a suspected VUJ calculus. This additional limited prone CT can prevent unnecessary urologic intervention.