Massive or Giant Vesical Calculus is A Rare Entity: A Case Report
Prof Dr Abdul Awal, Dr Shihab Arefin Chowdhury
Massive or giant vesical calculus is a rare entity in the recent urological practice and these have been found to grow to enormous proportions with minimal or no symptoms. Males are affected more than the females. Vesical calculi are usually secondary to bladder outlet obstruction. These patients present with recurrent urinary tract infection, haematuria or with retention of urine. Two such stones were removed from the urinary bladder of a 50 year old Bangladeshi male who came to the Accident & Emergency department of United Hospital with profuse haematuria, penile swelling & tenderness with purulent yellowish discharge. Patient had severe lower abdominal tenderness with a urinary catheter in-situ. The patient was quadriplegic for more than a decade, as a result of post-rabies vaccination complication and also had other co-morbidities like diabetes, hypertension, critical triple vessel disease, with history of recent ventricular tachycardia and non-ST elevation MI (NSTEMI) upon which he was resuscitated from cardiogenic shock. The patient developed these symptoms in early January 2017 and was in and out of several hospitals with these problems due to lack of adequate facilities to manage surgery related cardiac risks. Before coming to United Hospital, patient visited four other big corporate hospitals of the city, from where he was refused surgery because of his multiple co-morbidities which posed risk for anaesthesia. Finally following admission, after detailed investigations and with sufficient cardiac risk precautions the patient underwent open cystolithotomy under local anesthesia as giving general & spinal anaesthesia was risky for him, hence the surgery needed to be completed not only with efficiency but also with promptness. Cystolithotomy is the surgical removal the bladder stones via a lower abdominal incision usually done under a sub-arachnoid block (spinal anesthesia); but in this case due to patient’s cardiac complication risks, open cystolithotomy was done under local anesthesia. During surgery, digital rectal help was needed to remove the stone as it was adherent with bladder mucosa. Post-operative period was uneventful. His urinary output was quite normal and had no defaecatory problems. Patient left the hospital 3 days after operation with penile catheter removed and with a supra-pubic catheter advised to be removed 14 days after the procedure. There are many causes of stone formation in urinary bladder as minerals like calcium or magnesium salts can deposit there and crystallize. In this patient the cause is assumed to be prolonged lying down since patient was quadriplegic for long time.