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Background: Inguinal herniation of the urinary bladder is rare. Although in most patients it is an incidental finding during hernia repair, some patients present with complications related to herniated bladder. Case Presentation: A 65-year-old man presented with recurrent lower urinary tract infections and multiple episodes of lithuria. He was found to have an incarcerated right inguinal hernia with a large part of the urinary bladder inside the hernial sac. He did not have any features of bladder outlet obstruction. The herniated bladder had multiple small secondary vesical calculi that had probably formed in this hernial sac. He was managed by open surgical mesh hernioplasty followed by cystoscopic stone evacuation. Conclusion: Incarcerated bladder herniation, complicated by intravesical stone formation, is a rare clinical condition. Proper preoperative imaging with CT scan best confirms the diagnosis. Appropriate treatment includes reduction of the bladder, hernia repair, and endoscopic stone management.

Intravesical migration is an uncommon but serious complication of intrauterine contraceptive devices. Calculus formation is common over such migrated intrauterine contraceptive devices. This dreaded complication usually presents with lower urinary tract symptoms such as suprapubic pain, frequency, and nocturia. We present a case of a 50-year-old woman with intravesical migration of copper-T device placed in the immediate postpartum period 25 years ago. She presented with dysuria, which was confirmed by computed tomography. The migrated device was encrusted with a 3.5-cm-sized stone around its vertical limb. Another stone of approximately the same size was present in the bladder. Surprisingly, the patient never had symptoms and hence she never followed up for 25 years. The stones could not be removed endoscopically, and therefore an open vesicolithotomy was performed. This case has been presented to highlight the significance of following up patients with intrauterine contraceptive devices to avoid potentially devastating complications.

Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.

Uterine prolase is a common gynaecological disease .It is usually associated with cystocele and or rectocele as well as enterocele. Recurrent urinary tract infections may occur in chronically unreduced cystocele leading to calculus formation,cystitis,pyelitis,pyelonephritis and renal failure.We report a case of a 70 years old multiparous lady with third degree uterovaginal prolapse for twenty years, presence of multiple vesical calculus in the cystocele was noted on X-ray pelvis while undergoing investigation.Suprapubic cystolithotomy followed by vaginal hysterectomy with pelvic floor repair was done. Multiple vesical calculus were removed. Postoperative course was uneventful and she was discharged on 10th post-operative day. Patient is still on follow up with good urinary function and no recurrent UTI.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 77-79

A 77-year-old man presented with voiding lower urinary tract symptoms with history of terminal haematuria. His ultrasonography (USG) was suggestive of a 58 g prostate with thickened urinary bladder walls along with two vesical calculi. A plain X-ray was taken that showed two radio-opaque shadows in the urinary bladder corresponding to vesical calculi reported on the USG. Along with that there were two serpentine radio-opaque shadows on each side of the urinary bladder (figure 1). The primary care physician thought these shadows to be ureteric calculi/calcification and referred the patient to our centre for further workup and management. On carefully reviewing the X-ray we immediately recognised that the serpentine radio-opaque …

Objective: To describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi. Patients and methods: This was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient’s symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications. Results: The mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days. Conclusion: Simultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible. Keywords: Benign prostatic hyperplasia, Vesical calculus, Simultaneous percutaneous cystolithotripsy with transurethral resection of prostate, Cystolithotripsy

Giant vesical calculi, though rare, are still encountered in contemporary urologic practice despite the increased availability, accessibility, and affordability of modern imaging modalities and urologic care. This is the case report of a middle-aged man with an unusually large vesical calculus. He presented with symptoms atypical of this disease. After the diagnosis, he was subjected to open cystolithotomy, bladder neck dilatation and bladder biopsy, leading to the relief of symptoms and improved voiding. Chemical analysis revealed the stone to be of the struvite type. Histological analysis of the biopsy specimens showed features of non-specific chronic inflammation. The patient’s further management will require regular follow- up examinations in order to ensure that possible recurrent bladder neck stenosis and/or bladder carcinoma are detected on time. Keywords : Atypical; Presentation; Enormous; Giant; Vesical; Calculus

Background: Bladder stone is a common disease in this part of our country. This study was undertaken to find out the role of urine analysis and radiology in the diagnosis of vesical calculi and average size of penis in such patients in Darbhanga district.Methods: This study was conducted among patients admitted with features of vesical Calculi in the upgraded Department of Surgery, Dharbhanga Medical College and Hospital, Dharbhanga. SPSS software was used for data analysis.Results: On routine urine examination oxaluria was observed in 63.3% of cases. On preoperative culture of urine, E. coli was the most common bacteria isolated (36.6%). Maximum number of stones were single, and most of them were found only in bladder by plain X-ray (K.U.B.). The average length of penis came down from 17 to 0.4 inch after one month of removal of stone.Conclusions: In the study plain X-ray (K.U.B.) was to be of great value in diagnosing the presence of stone.

In the seventeenth century, Holland and the allied provinces of the northern Netherlands won final independence from their Spanish overlords and formed a worldwide economic empire. Dutch ships dominated the seas from the Caribbean to Japan and reconnoitred the coasts of Australia and New Zealand. Dutch society was cosmopolitan and supported great painters, philosophers and scientists. In these astonishing years, the physician Nicolaes Tulp [1593-1674] practised medicine in Amsterdam and, in 1641, published a book of his medical observations. This book ran into many editions; the Cowlishaw collection contains one of the last, dated 1716. Tulp is best known as the chief figure in a famous painting by Rembrandt, but his book has been studied by medical historians as a source of early descriptions of cranial surgery, spina bifida, vesical calculi, beriberi and many other conditions. The book is also a mirror of Dutch society in a great period in European history.

Background: The occurrence of huge vesical calculi complicating genital prolapse is rare. But it may lead to obstructive uropathy, as well as a management dilemma for the treating clinicians. In this paper, we report on a 70-year-old woman who presented with a uterovaginal prolapse with a single, large vesical calculus, which led to an incarceration of the prolapsed uterus and obstructive uropathy. She underwent a vaginal hysterectomy and cystolithotomy procedure, which resulted in the resolution of uropathy.

Urinary bladder stone is a rare cause of mechanical dystocia. We report a case of mechanical dystocia due to two large vesical calculi. The diagnosis was made during labor when on vaginal examination two large stone of sizes 5x5 cm and 5x4 cm were palpated from the anterior vaginal wall pushing the cervix to one side and obstructing the descent of head. Emergency caesarean section was performed along with simultaneous removal of urinary bladder stones by cystolithotomy. The post operative period was uneventful.

Bladder calculi associated with benign prostatic hyperplasia are fairly common, and a popular treatment is transurethral resection of the prostate (TURP) with endoscopic lithotripsy as a combined procedure. We have been routinely using a Reuter's suprapubic trocar and cannula for continuous irrigation during TURP for medium-size and large glands. Rather than performing the vesicolithotripsy per urethra, we have found it easier and faster to use the suprapubic route, especially because the suprapubic tract was already partly made by the Reuter's trocar and half sheath. We describe the technique in detail and explain why we find it easier to extract the stone by the suprapubic rather than the urethral route.

Objective: Few studies have explored the diuretic property of fennel (Foeniculum vulgare). Hence, the aim of this study was to evaluate the antiurolithiatic property of ethanolic extract of fennel seeds in male Wistar albino rats.Methods: Prophylactic and curative urolithiasis models were used with 5 groups of 6 rats in each model. Ethanolic extract of fennel seeds in three doses 100, 200, and 300 mg/kg was used. Cystone 750 mg/kg was used as a standard drug. All drugs were administered orally. Zinc discs were surgically implanted in the bladder in all rats. After recovery, rats in the prophylactic model received three different doses of ethanolic extract of fennel seeds along with 1% ethylene glycol for 2 weeks whereas the rats in the other model received 1% ethylene glycol for 2 weeks followed by an ethanolic extract of fennel seeds in three doses for the next 2 weeks. Both models had a control group receiving 1% ethylene glycol. At the end of study period, rats were sacrificed and vesical calculi collected, weighed, and statistically evaluated using one-way ANOVA.Results: In both the models, all three doses of an extract of fennel seeds were effective in reducing stone formation as compared to control group with p

Introduction Here we report an unusual case of massive stone formation in augmented urinary bladder. Case presentation A 25-year-old man presented with recurrent urinary tract infection ten years after augmentation cystoplasty after a complex pelvic fracture urethral distraction defect. On evaluation by ultrasonography, X-ray, and computed tomography of abdomen showed large burden of stones in the urinary bladder. Patent underwent an open cystolithotomy and forty stones weighing about 1400 g were removed. It was one of the largest reported stone burdens following augmented cystoplasty until now. Discussion Even though stone formation is a common complication after augmentation cystoplasty, it can be prevented by regular bladder wash and good follow-up.

The advent and development of extracorporeal shock-wave lithotripsy (ESWL) have revolutionized the treatment of most renal and ureteral calculi. Some patients, however, still are managed most effectively by endoscopic means. In this context, percutaneous and transurethral ureteroscopic extractions of calculi have become well-established techniques in urology. Even with the most ingenious endoscopic equipment and techniques, the diameters of the working sheath used during percutaneous nephrolithotripsy and the dilated or undilated ureteral orifice during ureteroscopy present a natural limitation to simple mechanical stone extraction. Similarly, although use of ESWL has been reported for the treatment of bladder calculi, intracorporeal lithotripsy, under endoscopic control, remains the mainstay of treatment for vesical calculi. A wide range of endoscopic lithotriptors have become available for fragmentation of urinary calculi. They can be divided broadly into three categories: direct-contact mechanical lithotriptors, devices which work by means of a shock-wave effect, and laser lithotriptors. Special characteristics of each lithotriptor are summarized in Table 1. To better understand the different types of intracorporeal lithotriptors, the authors review the mechanism of action, advantages, limitations, and associated costs for capital and disposable items.

Transuterine transvesical emigration of an intrauterine contraceptive device is a rare and uncommonly described complication of an intrauterine device. We report and describe the clinical outcome and management of one such case of intravesical intrauterine device that had become calcified leading to the erroneous diagnosis of a vesical calculus. The diagnosis was confirmed after cystoscopic visualization, lithoclasty and extraction of the calcified plaque consisting of the Cu-T. A migrated IUD is a rare and infrequent cause for the formation of secondary vesical calculi. The treating surgeon should be aware of the possibility of such episodic cases of vesical calculi occurring in the women presenting with recurrent unexplained urinary sepsis.

Vesical calculus associated with uterovaginal prolapse is very rare. We report a case of a 70–year –old multiparous lady with third degree uterovaginal prolapse for twenty years .Presence of multiple vesical calculus in the cystocele was noted on ultrasonography and x-ray pelvis while undergoing investigation for acute urinary retention. Vaginal hysterectomy with pelvic floor repair followed by suprapubic cystolithotomy was done in the patient. Multiple vesicle calculus were removed. Post operative course was uneventful. Bladder outlet obstruction resulting from prolapse is suspected to be the inciting factor in stone formation though the casual relationship between prolapse and vesical calculus is not established.DOI: http://dx.doi.org/10.3126/hren.v12i1.11989Health Renaissance 2014;12(1):55-56

A giant vesical calculus more than 100 gram is rare entity. Fewer than 30 cases are reported in English literature of vesical calculus more than 100 gm. Largest vesical calculus was of weight 6294 gm by Arthure et al. Available treatment options for vesical calculi include open surgical removal, extracorporeal fragmentation and endoscopic crushing followed by extraction of pieces. Recently, endosurgical mechanical cystolithotripsy followed by percutaneous extraction has been evolved for small or moderate-sized calculi. Our case report demonstrated vesical calculus of 400gms which is a rare finding in today urologic practice.

In the traditional Indian system of medicine Crateva nurvala (Hindi: Varuna) constitutes a major ingredient of formulations used to treat urinary disorders including urolithiasis. In an earlier study we confirmed the antiurolithiatic activity in the crude extract of the plant, and further fractionation led to the isolation of the active constituent lupeol (Lup-20(29)-en-3β-ol). Antiurolithiatic activity of lupeol was assessed in rats by observing the weight of the stone, biochemical analysis of serum and urine, and histopathology of bladder and kidney. Lupeol not only prevented the formation of vesical calculi but also reduced the size of the preformed stones.

The bladder is the most commonly affected site for stone formation in the lower urinary tract. The incidence of vesical calculi has declined significantly in the last 50 years in developed countries due to improvements in nutrition and diet. Bladder calculi can be classified as primary idiopathic/endemic, migrant, and secondary calculi. Primary idiopathic/endemic bladder calculi are those calculi that form typically in children, in absence of bladder outlet obstruction/neurogenic bladder leading to urinary stasis, urinary tract infection, or foreign body.

From October 1988 through December 1990, we treated 1221 male and 784 female patients aged 2 to 84 years for urolithiasis using the Dornier MPL-9000 lithotripter. Stones were located in calices or the renal pelvis in 34% of cases each, in the ureter in 17%, and in the bladder in 0.8%. Twelve per cent of the stones were branched renal calculi. The mean volume of the stones was 16 cm3 for branched calculi, 8 cm3 for renal pelvic calculi, 1.8 cm3 for caliceal calculi, 1.5 cm3 for ureteral calculi, and 19 cm3 for vesical calculi. In the 35% of patients who had stone volumes larger than 5 cm3, a ureteral stent was introduced before treatment. The kilovoltage was adjusted according to the size and location of the calculi. The average number of shock waves was 2150. It was necessary to re-treat 35% of the patients, with some having as many as 10 sessions, and the total number of sessions in the series was 3380. However, it proved possible to fragment 94% of the stones, with 80% of the patients being stone free a...

The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations.Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours.All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access.Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.

Objectives: To study the pattern and demographic features of patients with urinary bladder calculi, in El Obeid Hospital; Western Sudan. Patients and Methods: In this study the recordsof sixty patients with urinary bladder stones were reviewed. The data were analyzed for age, sex, locality, clinical features, the treatment offered and outcomes. Results: The male: female ratio was 14:1. 53 patients (88.3%) were children, below 10 years. The majority were from distant rural areas with features of malnutrition and anaemia. 7 patients (11.7%) were adults with urinary outlet obstruction. Conclusions: Urinary bladder calculi were prevalent in children from rural areas with features of malnutrition, where as such calculi were not uncommonly found in adults from the same background secondary to urinary outlet obstruction. Keywords : Urinary bladder stones, Western Sudan. Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 29-32

Giant vesical calculus is a rare clinical entity in modern urological practice. Vesical calculi are usually secondary to bladder outlet obstruction. The usual clinical presentation is with recurrent urinary tract infection, haematuria or with retention of urine. We report an elderly male patient who presented with azotaemia and anuria as a result of bilateral obstructive uropathy due to a giant vesical calculus.

Background and purpose: We compare two modalities of treatment; transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL), for large vesical calculi in patients who underwent simultaneous transurethral resection of prostate (TURP), and present refinements of the technique of PCCL. Patients and methods: Between July 1999 and June 2003, 54 patients were subjected to either TUCL (n = 19) or PCCL (n = 35) along with simultaneous TURP. Inclusion criteria were prostate volume > 50 ml, aggregate stone size > 3 cm with each individual stone > 1 cm, In the TUCL group, calculi were treated with 26F nephroscope, pneumatic lithotripsy and fragment extraction. This was followed by TURP with 26F continuous-flow resectoscope. In the PCCL group, calculi were removed through a suprapubic 30F Amplatz sheath followed by standard TURP with the suprapubic sheath in situ to provide continuous drainage. A 20F two-way Foley catheter was inserted suprapubically and urethrally in cases of PCCL and a 22–24F three-way catheter urethrally after TUCL. Results: The two groups were comparable in age. The mean prostate size as well as aggregate stone size was significantly larger in PCCL group. The operating time for stone removal was significantly less in the PCCL group while time required for TURP was statistically similar in two groups. In the TUCL arm three patients had residual stones requiring repeat TUCL, and one developed a urethral stricture.Conclusions: Combined TURP and PCCL is safe, more effective and a much faster alternative to combined TURP and TUCL in patients with large bladder calculi and large prostates.