Giant bladder calculus in a male patient with chronic alcoholic liver disease

Abstract

Introduction: Giant bladder calculus in recent urologic practice is uncommon. Bladder calculi have been known to grow to significant sizes in delayed presentations. They may be associated with chronic liver disease. Literature search revealed few studies suggesting a link between chronic liver disease and urolithiasis. Case Report: A 23-year-old man presented to us with 17 year history of frequency, urgency, weak stream, feeling of incomplete emptying of the bladder, strangury, total painless hematuria and yellowness of the eyes of same duration. He also had a history of ingestion of alcohol for the past 10 years. On examination, he was pale and icteric. Abdominal examination revealed hepatomegaly and a hard non-tender suprapubic mass. Other systems were essentially normal. Urinalysis revealed triple phosphate crystals but his urine culture was negative. He had deranged renal and liver function tests. Serum calcium was low, 4.8 mg/dL, phosphorus was 13.93 mg/dL. He was nonreactive to Hepatitis B and C. Ultrasonography revealed an enlarged liver measuring 18 cm, echogenic foci with posterior acoustic shadowing in both kidneys, dilatation of both pelvicalyceal systems with a solid echogenic mass occupying the whole of the bladder lumen. Plain abdominal X-ray revealed a huge radio opaque mass measuring 10 cmx6 cm, occupying the pelvic region and radio opaque masses measuring 2 cm x 2 cm in both kidneys. A diagnosis of urolithiasis (huge bladder calculus and nephrolithiasis) with chronic alcoholic liver disease was made. He had open cystolithotomy under spinal anaesthesia. No obstructive lesion was seen. The calculus measured 12cm x 9cm x 6cm, weighed 1.5 kg and was adherent to the bladder mucosa. The calculus was removed and he was placed on continuous bladder drainage for 10 days, following which the catheter was removed. He has been on regular follow up in the outpatient clinic since discharge. He has no lower urinary tract symptoms but jaundice is still present. Conclusion: Giant bladder calculus is rare and should be considered in patients with long standing lower urinary tract symptoms and strangury. There may be an association between chronic liver disease and bladder calculus.