|Year : 2022 | Volume
| Issue : 3 | Page : 236-237
A giant vesical calculus
Gopalakrishnan Chandrasekaran, Chelian Mathirajan, Rajasabai Pandiarajan
Department of Urology and Anesthesiology, Nithilaa Nursing Home, Madurai, Tamil Nadu, India
|Date of Submission||29-Mar-2022|
|Date of Acceptance||20-May-2022|
|Date of Web Publication||1-Jul-2022|
Department of Urology and Anesthesiology, Nithilaa Nursing Home, Madurai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Vesical calculi are common in urological practice. However, encountering a giant vesical calculus weighing more than 100 g is rather rare. We report a patient who presented with mild symptoms and was found to have a single giant vesical calculus weighing about 1334 g. Lack of access to basic medical facilities and milder symptoms may be the predisposing factors in this patient for a calculus to enlarge into such abnormal weight.
|How to cite this article:|
Chandrasekaran G, Mathirajan C, Pandiarajan R. A giant vesical calculus. Indian J Urol 2022;38:236-7
| Case|| |
A 30-year-old male presented with lower abdominal discomfort of almost 1-year duration. On examination of the abdomen, a hard, nontender mass of size 15 cm × 10 cm was palpable in the hypochondriac region. X-ray kidney, ureter, and bladder, showed a huge densely radio-opaque shadow in the region of the urinary bladder. The computed tomography scan abdomen findings revealed a giant vesical calculus of size 14.7 cm × 11.4 cm × 10.4 cm [Figure 1]. Bilateral hydroureteronephrosis and renal cortical thinning were present. Under regional anesthesia, cystoscopy was done. The bladder neck was elevated, and a whitish marble-like huge calculus was seen occupying the whole bladder with no space for the cystoscope sheath to be advanced. An open vesicolithotomy was performed using the obstetric outlet forceps. The giant vesical calculus was found to weigh 1334 g (Inset) with the size of about 17 cm × 13 cm. The composition of the calculus was calcium oxalate.
|Figure 1: CT scan abdomen sagittal section showing giant vesical calculi with inset showing the 1334 g calculi on the weighing scale. CT: Computed tomography|
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| Discussion|| |
Once the vesical calculus exceeds 100 g by weight, it is termed as giant vesical calculus. In 1953, Arthure reported the single largest vesical calculus in the world, weighing 6294 g. In recent years, a single calculus weighing 1600 g was reported in Nigeria. We report our patient with a single giant vesical calculus size of 1334 g. Giant vesical calculi present with no symptoms or with minimal urinary symptoms, which are usually well tolerated. This delays the need for early treatment and predisposes to the formation of the giant vesical calculi. Lack of medical facilities, poor access to health clinics, and illiteracy are also predisposing factors. Endemic childhood bladder calculi in developing countries may be a contributory factor. Treatment is ideally by open vesicolithotomy due to the massive weight and size. A single giant vesical calculus of this massive weight is really very rare in this modern era of diagnostic facilities.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
The authors declare that no funding has been received for the preparation of this manuscript.
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
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