Patient: 35-year-old male living in Iran
Symptoms: A man visited the urology department of a hospital complaining of bladder discomfort. He had no problems urinating and had no history of surgery or disease in that part of his body. Nor did he experience the typical symptoms of a urinary tract infection, such as constantly feeling the need to urinate or a burning sensation while urinating.
What happened next: Doctors performed a physical examination of the man’s abdomen and detected a large, smooth, hard mass above the pubic bone, at the front of the pelvis where the two pubic bones are connected by cartilage.
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According to the man’s case report, the dense mass was not attached to the pelvic region or abdominal wall, and ultrasound examination revealed it to be an oval-shaped object approximately 11 centimeters in diameter.
Diagnosis: Doctors at the hospital identified the mass as an abnormally large bladder stone. These objects, also known as stones, grow when minerals in the urine build up into crystals. About 85% of their composition is calcium. If the bladder does not empty completely, they can form in the bladder, which causes the minerals in the urine to concentrate and crystallize.
Bladder stones usually form directly in the bladder, but in some cases they can develop from small kidney stones that travel from the kidneys to the bladder or into the muscular tubes between the bladders called ureters.
The smallest bladder stones are invisible to the naked eye, but they vary widely in size. Small stones usually go undetected and are passed during normal urination. However, larger stones can block the flow of urine and irritate the walls of the urinary tract, causing pain, interrupted urination, or internal bleeding.
Treatment: After making sure that the egg-like stone was not blocking or narrowing any part of the patient’s urinary tract, doctors removed the stone in a surgery 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 was approximately 5 inches (13 centimeters) long, 4 inches (10 centimeters) wide, and 3 inches (8 centimeters) high.
Surgeons placed a catheter to help the man urinate while he healed, and removed it seven days after surgery.
Features of this case: Although urinary tract stones are relatively common, bladder stones only account for about 5% of cases, and kidney stones are much more common. Case reports say large stones that affect patients and require surgical removal are “extremely rare.”
Remarkably, this giant stone appears smaller than the current record holder for bladder stones, a mass that weighs 4.2 pounds (1.9 kilograms) and measures 7 inches (17.9 cm) long. Doctors in Brazil surgically removed the stone from a male patient in 2003.
Still, the large size of the bladder stone removed from the Iranian man was highly unusual, the surgeons wrote. “Regarding the stone characteristics in our case, our report was the first not only in Iran but also in the world,” they said.
This article is for informational purposes only and does not provide medical advice.
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