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Year : 2019  |  Volume : 14  |  Issue : 2  |  Page : 109-110

Large bladder stone formed over suprapubic cystostomy catheter leading to renal failure: An uncommon complication

Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Ananthpuram, Andhra Pradesh, India

Date of Submission31-Dec-2018
Date of Decision03-Mar-2018
Date of Acceptance24-Apr-2019
Date of Web Publication25-Nov-2019

Correspondence Address:
Dr. Prateek Jugalkishore Laddha
Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Ananthpuram - 515 134, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_92_18

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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 2022 Aug 16];14:109-10. Available from: http://www.journaldmims.com/text.asp?2019/14/2/109/271559

  Introduction Top

Urinary bladder stones constitute 4%–10% cases of urinary stones. The common causes include bladder outlet obstruction, bladder diverticulum, foreign bodies, and neurogenic bladder.[1] 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].
Figure 1: Ultrasound showing large bladder stone

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  Case Report Top

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

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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

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  Discussion Top

Urinary bladder stones comprise around 4%–10% of all stones in the urinary tract.[1] 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.[2] 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.[3] 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.[4] 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.[5] 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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Trinchieri A. Epidemiology of urolithiasis: An update. Clin Cases Miner Bone Metab 2008;5:101-6.  Back to cited text no. 1
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.  Back to cited text no. 2
Robinson J. Suprapubic catheterization: Challenges in changing catheters. Br J Community Nurs 2005;10:461-2, 464.  Back to cited text no. 3
Wei W, Wang J. A huge bladder calculus causing acute renal failure. Urol Res 2010;38:231-2.  Back to cited text no. 4
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.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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