|Year : 2019 | Volume
| Issue : 2 | Page : 109-110
Large bladder stone formed over suprapubic cystostomy catheter leading to renal failure: An uncommon complication
Gaurav Kochhar, Sharanabasappa Baburao Rudrawadi, Prateek Jugalkishore Laddha, Prathik Ramadev
Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Ananthpuram, Andhra Pradesh, India
|Date of Submission||31-Dec-2018|
|Date of Decision||03-Mar-2018|
|Date of Acceptance||24-Apr-2019|
|Date of Web Publication||25-Nov-2019|
Dr. Prateek Jugalkishore Laddha
Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Ananthpuram - 515 134, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Urinary bladder stones commonly develop in sitting of bladder outlet obstruction and infection. We had one patient who had large bladder stone causing renal failure, which is an uncommon complication. The patient had a suprapubic cystostomy catheter inserted for urethral stricture two years back. This case highlights the uncommon complication of urinary bladder stone and the importance of proper patient education.
Keywords: Bladder stone, cystolithotomy, renal failure, suprapubic catheterization
|How to cite this article:|
Kochhar G, Rudrawadi SB, Laddha PJ, Ramadev P. Large bladder stone formed over suprapubic cystostomy catheter leading to renal failure: An uncommon complication. J Datta Meghe Inst Med Sci Univ 2019;14:109-10
|How to cite this URL:|
Kochhar G, Rudrawadi SB, Laddha PJ, Ramadev P. Large bladder stone formed over suprapubic cystostomy catheter leading to renal failure: An uncommon complication. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Apr 4];14:109-10. Available from: http://www.journaldmims.com/text.asp?2019/14/2/109/271559
| Introduction|| |
Urinary bladder stones constitute 4%–10% cases of urinary stones. The common causes include bladder outlet obstruction, bladder diverticulum, foreign bodies, and neurogenic bladder. They often remain asymptomatic, but if left untreated can cause varied symptoms. Renal failure is a rare complication of bladder stones. Hereby, we report a case of large bladder stone formed over the catheter bulb, which had led to obstructive uropathy and postrenal failure [Figure 1].
| Case Report|| |
A 65-year-old male patient presented to the emergency department with complaints of bilateral loin pain and decreased urinary output through suprapubic cystostomy catheter placed cystostomy catheter for 1 week. The patient occasionally experienced episodes of fever and emesis. He had a history of suprapubic catheterization 2 years back for an episode of urinary retention due to urethral stricture. After that, he was lost to follow-up. There were no comorbidities. Ultrasonography revealed bilateral gross hydroureteronephrosis with internal debris along with the presence of a large bladder stone of size 7.3 cm × 5.8 cm [Figure 2]. An X-ray of the Kidney ureter bladder (KUB) region was also done [Figure 2]. Blood investigations showed a total leucocyte count (TLC) of 17,000/cc, blood urea of 227 mg%, and serum creatinine of 4.5 mg%. All the other investigations were unremarkable.
|Figure 2: X-ray showing large bladder stone and bilateral nephrostomy tubes in situ|
Click here to view
The patient was admitted and started on parenteral antibiotics. Urgent bilateral tube nephrostomies were done, and pus was ordered for culture and sensitivity. The patient responded to the management, and his renal function tests came out to be normal. He was taken for open cystolithotomy. The intraoperative finding was suggestive of a large vesicle calculus formed around the catheter bulb. The catheter along with the bladder stone was removed [Figure 3]. The postoperative period was uneventful. Tube nephrostomies were removed on postoperative day 5. The patient was discharged on the 5th postoperative day with a plan of the management of urethral stricture.
|Figure 3: Postoperative picture showing suprapubic cystostomy catheter with large stone formed over the balloon of the catheter|
Click here to view
| Discussion|| |
Urinary bladder stones comprise around 4%–10% of all stones in the urinary tract. They commonly result from bladder outlet obstruction leading on to urinary stasis and infection. Urinary bladder stones remain largely asymptomatic or have vague symptoms. The development of bacteriuria after a urinary catheter is a sequel, with a rate of around 10% per day after catheterization. There are two subsets of population of bacteria in the urinary system of a bacteriuric patient. The first one is the bacteria which grow in the urine suspension termed as “plankton” growth, and the second one is the growth of bacteria over the surface of the catheter termed as “biofilm” growth. The bacterial products interact with the host proteins and lead to encrustation of the catheter. The encrustation is due to the deposition of struvite or calcium phosphate particles. It occurs due to alkalinity of the urine from the production of ammonia by urea-splitting bacteria such as Proteus and Pseudomonas. Various materials have been described as resistant to encrustation, but tend to form encrustations sooner or later.
Despite “not so rare” incidence of bladder stones, this disease is rarely reported to cause renal dysfunction and subsequent renal failure. The bladder stones remain mobile inside the bladder. However, if they grow and attain a large size, then they can cause bladder neck obstruction and hence leading to obstructive uropathy. The treatment comprises of removal of the stone either via open or endoscopic route and treatment of the cause, which had led to the stone development. We did open cystolithotomy in our patient in view of large stone burden.
Good local hygiene, proper care of the catheter, and closed drainage system are vital to prevent bacteriuria and encrustation. Regular catheter change and proper patient education should be done.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Trinchieri A. Epidemiology of urolithiasis: An update. Clin Cases Miner Bone Metab 2008;5:101-6.
Ramsay JW, Garnham AJ, Mulhall AB, Crow RA, Bryan JM, Eardley I, et al
. Biofilms, bacteria and bladder catheter. Br J Urol 1989;64:395-8.
Robinson J. Suprapubic catheterization: Challenges in changing catheters. Br J Community Nurs 2005;10:461-2, 464.
Wei W, Wang J. A huge bladder calculus causing acute renal failure. Urol Res 2010;38:231-2.
Minter J, Chiovaro J. Renal failure with a large bladder calculus related to a foreign body: A case report. Clin Case Rep 2014;2:48-50.
[Figure 1], [Figure 2], [Figure 3]