bladder stone -case report

8/3/2019 Bladder Stone -Case Report

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Case report

Impacted bladder stone a cause of renal failure

Mukosai S, Silumbe M, Kalo, Nenad, Prof Labib Mohammed, Kachimba J

Department of Surgery, Division of Urology

Abstract

We present a case of 10 year old child from Kafue district who presented with features of renal

failure, bilateral hydronephrosis secondary to impacted bladder stone of size 4.5x4cm. Bladder

stones though a common urological condition rarely cause obstruction[1]. In this case report

Patient was managed by early renal support through peritoneal dialysis, blood transfusion and

removal of bladder stone by open method after which satisfactory results were achieved. The case

illustrates the importance of early radiological intervention in any patient who presents with

recurrent urinary tract infections, especially in male patients.

Introduction

Bladder stones commonly manifest with clinical presentation of irrigative urinary symptoms and few

obstructive symptoms. Bladder stone is a common urological disease, but it is rare for such a

calculus to be so large as to cause bilateral hydronephrosis [2]. Impacted bladder stone can result in

obstructive uropathy and renal failure [3]. The aetiology and pathogenesis of bladder stones remain

obscure [4]. Bladder stones can be easily diagnosed with simple radiological investigations such

plain x ray KUB and ultrasonography to enable early diagnosis and prompt interventions. We are

reporting a case presented to our hospital of impacted bladder stone presenting with renal failure.

Case report

A 10 year old male child presented to urology clinic with a 3 year history of voiding dysfunction

characterised by difficulty in voiding and constant tapping at the phallus with recurrent febrile illness

caused by recurrent urinary tract infections. The child has had history of loin pain for similar

durations. He had been treated for UTI at a local hospital. He denies history of hematuria. Plain KUB

revealed radiopaque shadows in the area of the bladder [figure3]. Urinalysis showed plenty of pus

cells with epithelial cells 3-5 HPF. There was no RBCc. Urine culture yielded Escherichia Coli which

was sensitive to nitrofurantoin. Renal function test revealed blood urea (BUN) 43.72mmol and

serum creatinine 635.8umol/l.

On physical examination, the child was ill health dyspnoeic wasted moderately pale afebrile to

touch. On systemic examination respiratory system was clear, cardiovascular system revealed

tachycardia with heart rate 100 b/m. Other systems were un remarkable.

Subsequent management involved strict in and and output, intravenous fluids, renal support with

peritoneal dialysis and received 3units of packed red blood cells. On day 5 post admission, the child

developed generalised convulsions controlled with diazepam and phenobarbitone episodes. He had

4 episodes in 2 days. Full septic screen done revealed negative for blood culture x 3 samples. Chest x

ray was not revealing. No growth in the urine. Lumbar puncture was not done because of un stable

child condition. He was covered on broad spectrum cefotaxime.

On day 20 of admission the child developed self limiting paralytic ileus which was managed

conservatively with nasal gastric tube and intravenous fluids {Ringers lactate}. Upon the child


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condition stabilising he was taken for Transvesical Cystolithotomy in which two bladder stones were

extracted, one impacted in the bladder neck size 4x4cm.

Figure 1


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Figure2

Figure 3


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Outcome

At post operative period the child developed post obstructive diuresis up to 4200ml/day. There was

subsequent dramatic improvement in renal function. Serum creatinine dropped to 109umol/l. He

was discharged to be followed up in the clinic on 20th

postoperative day with good urinary stream

out put and mild occasional urinary incontinence.

Figure 4

Literature review/ DiscussionBladder calculi are uncommon cause of illness in most western countries, but result in specific

symptoms and are a significant discomfort [5]. These stones are usually associated with urinary

stasis but can form in health individuals without evidence of anatomic defects, strictures, infections

or foreign bodies [6]. Malnutrition has been attributed to formation of primary bladder stones which

is still common in developing countries where malnourishment is common especially in growing

children [7].

A few international articles have reported bladder stone causing renal failure.

Wuran W. et al, from Harvard Medical School, reported a 62 year old man presented with large

bladder calculus causing bilateral obstruction and renal failure. Diagnosis was delayed despite the

patients history of recurrent urinary y tract infection [8].

Borg Z. et al , from Poland, reported a case of severe exacerbation of chronic renal failure with

bilateral hydronephrosis and urosepsis caused by asymptomatic large bladder stone. Managed bytemporally haemodialysis, removal of stone and controlling of severe urinary tract infection.

Kamal F, et al reported a case of 30 year old man who presented with obstructive renal failure and

urosepsis. Due to bladder outlet obstructing bladder calculi that formed around three copper wires

that were self inserted into urinary bladder 15 years previously [9].

Most bladder stones are mobile within the bladder due large space and thus continuous flow of

urine [10]. If untreated bladder stones can grow big in size causing mechanical obstruction by

impinging pressure on the Ureteric orifice within the bladder and also by being impacted on the

bladder neck leading to infravesical obstructive uropathy. Management of such cases is focused on


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patient stabilisation with temporal peritoneal or haemodialysis , early removal of stone ,continue

renal support treatment, correct acidosis and look out for post obstructive diuresis in the post

operative period. Surgical intervention by open Cystolithotomy or endoscopic Cystolithotomy can

achieve satisfactory results [9]. It is advisable to manage patients in cooperation with nephrologists.

Efforts must made to investigate the primary cause of repeated urinary tract infections through

radiological investigations like plain x-ray KUB and ultrasonography in patients with voiding

problems[ 10].

Conclusion

Bladder stone if large enough or if impacted in the bladder neck can cause obstructive uropathy

leading to renal failure. Recurrent urinary tract infections should be adequately evaluated with

radiological investigations for early and prompt diagnosis of the cause.

References

1 .Daeschner C.W, Single J.C.C [1960], Urinary Tract Calculi and Nephrocalcinosis in infants and

Children .Vol.57 Issues pages 721-732

2. Sundaram CP, Houshiar AM, Reddy PK. [1997], Bladder stone causing renal failure. Minn Med.

Sep; 80(9): 25-6.3. Dorairajan L.N, Talmer & Hemal A.K [2001), Stone Neclace of Urinary tract presenting as renal

Failure.

4. Aurora A.L, Taneja O.P, Gupta D>N [2008] Bladder Stone Disease of Childhood; An

Epidemiological Study.

5. Fadi Kamal, MD,*

Aaron T.D. Clark, MD,*

Luke Thomas Lavalle, BSc,

Matthew

Roberts, MD,* and James Watterson, MD* Intravesical foreign bodyinduced bladder calculi

resulting in obstructive renal failure

6. Wuran Wei1 and Jia Wang [2009] A huge bladder calculus causing acute renal failure, urological

research.

7 S. Madjar1, B. Moskovitz1, A. Kastin1, M. Stein1 and O. Nativ [1996], Anuria and acute renalfailure caused by multiple bladder calculi

8 Wuran W. Harvard Medical School, Large bladder causing hydronephrosis.

9 Kamal F,bladder outlet obstruction due renal calculi

10. Joshi B R*,Shrestha PM Can Urinary Bladder Stones Cause Renal Failure?

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