Abstract
A79-year-old male presented with a 1 ½-year history of gross hematuria and slowly increasing irritative voiding symptoms including frequency (up to every 10 minutes), nocturia and urinary incontinence. The patient did not have any significant travel history and did not pass visible amounts of stone material in urine. Prior history is significant for computerized tomography of the abdomen/pelvis that was performed approximately 1 year previously. It failed to demonstrate bladder calcifications but revealed a mildly thickened bladder wall and enlarged prostate. Subsequent cystoscopy similarly found no bladder stones or tumor and only mild bladder trabeculation. The patient underwent transurethral microwave thermotherapy for bladder outlet obstruction, and was seen 5 months later in the emergency department with the presence of left hydronephrosis, hydroureter and a calcified bladder wall. An extensive transurethral bladder resection with multiple calculi removal was performed, and stone analysis (including a 3.031 gm calculus) revealed a mixed composition of urate and magnesium ammonium phosphate (struvite). Pathological examination showed calcific and necrotic debris with the presence of cystitis cystica. Followup cystoscopy performed 2 months later found recurrent, severe cystolithiasis and the patient was referred for additional evaluation. At presentation urinalysis revealed a brown specimen with more than 100 red blood cells per high power field, 1 to 3 white
Published Version
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