BACKGROUND: This is a rare case of two large urinary bladder stones causing severe infection of the urinary tract affecting the bone marrow due to chronic immune stimulation in a patient with recurrent anemia. Urinary bladder calculi are hard masses of minerals. They develop when the minerals in concentrated urine crystallize. This often happens when the bladder cannot be emptied. Signs and symptoms can vary from severe abdominal pain to blood in the urine. Sometimes, bladder stones don't cause any symptoms. If left untreated, bladder stones may lead to infections and other complications such as hepatic abscess via a hematogenous route. CASE: This is a case of a seventy-eight-year-old man with a history of multiple blood transfusions secondary to anemia of unknown cause. He came into our institution for a second opinion. We worked up the patient, which showed hepatic abscess and two large urinary bladder calculi. Further investigation of the anemia later led to a diagnosis of primary myelofibrosis. DIAGNOSTICS: Ultrasound showed a complex mass on the left hepatic lobe measuring 7.5 cm x 6.0 cm x 2.1 cm consistent with a hepatic abscess. The culture of the abscess was positive for E. coli. Computed Tomography (CT) scan of the lower abdomen showed heterogeneous mass measuring 8.6 cm x 8.7 cm x 9.2 cm within the urinary bladder (see Figure 2). Urinalysis was consistent with a urinary tract infection. Urine culture showed E. coli. Video-assisted cystoscopy showed two urinary bladder calculi, measuring 1.5 cm x 3.2 cm x 4.2 cm weighing 30 grams each (see Figure 3). The calculi were composed of 100% Calcium Oxalate. He underwent a series of diagnostic examinations for anemia including gastroscopy to rule out a bleeding ulcer. Complete blood count showed hemoglobin of 77 g/L and a hematocrit of 0.23. Finally, bone marrow core biopsy was done which is consistent with primary myelofibrosis. CONCLUSION: Urinary bladder stones can be asymptomatic and may present only with vague abdominal pain. It should be one of the considerations in asymptomatic patients with long-standing prostatitis or benign prostatic hyperplasia. Detailed history, thorough physical examinations, and cautious diagnostic tests are mandatory to confirm the diagnosis. A hepatic abscess may arise from infections in the urinary tract such as prostatitis through hematogenous extension. Therefore, it is important to address the origin of the infection to prevent such complications. This is a rare case of an elderly man who presented with chronic anemia and later found out to have large urinary bladder stones that caused severe infection leading to immune stimulation of the bone marrow, hence the diagnosis of primary myelofibrosis by bone marrow biopsy. Such a rare case must be thought of holistically and analytically.
Male ; Prostatitis ; Prostatic Hyperplasia ; Urinary Bladder Calculi ; Liver Abscess ; Anemia

BACKGROUND: This study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast.METHODS: Between January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into three groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively com-pared between three groups.RESULTS: No statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1, 71.3±46.6 min; group 2, 33.0±13.7 min; and group 3, 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient.CONCLUSION: Nephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.
Cystoscopes ; Cystoscopy ; Humans ; Retrospective Studies ; Sex Ratio ; Ultrasonics ; Urinary Bladder Calculi ; Urinary Bladder

Macroplastique injection is safe and efficacious with a low complication rate. So this material is used commonly in vesicoureteral reflux patient. The risk of bladder mucosal necrosis and substantial decreases in volume after implantation were known as major complication of subureteral injection therapy. I present bladder stone growing from injection site of Macroplastique.
Humans ; Necrosis ; Urinary Bladder Calculi* ; Urinary Bladder* ; Vesico-Ureteral Reflux*

PURPOSE: Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. METHODS: A retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. RESULTS: Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. CONCLUSIONS: We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.
Adult ; Child ; Compliance ; Follow-Up Studies* ; Humans ; Ileum ; Lost to Follow-Up ; Male ; Retrospective Studies ; Urinary Bladder Calculi ; Urinary Bladder* ; Weight Gain

OBJECTIVE: Holmium laser enucleation of prostate (HoLEP) is as fast-paced treatment that is one of the standard treatment for benign prostate hypoplasia. However, there is a rare case that the satisfaction rate of surgery is lowered due to storage symptoms such as frequency and urgency. We investigated the risk factors of bladder irritation symptoms persisted after holmium laser enucleation of prostate. METHODS: From January 2009 to December 2014, 220 patients underwent HoLEP in Soonchunhyang University Cheonan Hospital. Among them, 133 patients were selected who did not have any problem that could affect the voiding function including urologic cancer, neurogenic bladder, urinary tract infection, and bladder stone disease. At 3 months after surgery patients were divided into two groups: postoperative International Prostate Symptom Score (IPSS) storage symptom scores <8 (group I) and ≥8 (group II). The two groups were analyzed the parameters: preoperative (prostate size, uroflowmetry, IPSS, prostate calcification), intraoperative (operative time, resected prostate weight), and postoperative (IPSS, uroflowmetry). RESULTS: Of the 133 patients, 94 patients were assigned to group I and 39 patients were group II. Age of the patients, the prostate size, and maximal urinary flow rate showed no statistical difference in both groups. Preoperative storage symptom scores were significantly higher in group II (P<0.05) and IPSS voiding-to-storage subscore ratio was lower in group II without significance (P<0.05). The prostate calcification, periurethral prostatic calcification, and intravesical prostatic protrusion was no difference in the two groups. Postoperative IPSS, maximal urinary flow rate, and post-void residual urine volume was improved in two groups but storage symptom score was not improved in group II. Operative time and resected prostate weight were not found the differences, and postoperative parameters (maximal urinary flow rate, post-void residual urine volume) were showed no difference in both groups. However all of the IPSS was higher in group II. CONCLUSION: Many symptom improvements after HoLEP were observed but some patients may have difficulties due to persistent bladder irritation. Because bladder irritation sign could persist after surgery if preoperative storage symptom score was higher, it is necessary for a detailed description before surgery.
Chungcheongnam-do ; Holmium* ; Humans ; Lasers, Solid-State* ; Operative Time ; Prostate* ; Prostatectomy ; Risk Factors* ; Urinary Bladder ; Urinary Bladder Calculi ; Urinary Bladder, Neurogenic ; Urinary Tract Infections ; Urologic Neoplasms

Intrauterine contraceptive devices (IUCDs) are a common form of reversible contraception owing to fewer systemic side effects and low cost, especially in a developing country like India. However, IUCDs are not without complications. Migration of a device into adjacent organs is the most morbid of all the documented complications. A patient who presents with a history that suggests loss or disappearance of an IUCD thread associated with urinary symptoms should raise suspicions that a device may have migrated into the bladder. Physicians should also be aware of possible secondary vesical calculus formation. Further radiological investigations and appropriate management are warranted. We present a case report describing the migration of an IUCD into the bladder with secondary calculus formation.
Calculi* ; Contraception ; Developing Countries ; Humans ; India ; Intrauterine Devices* ; Urinary Bladder ; Urinary Bladder Calculi

PURPOSE: To assess the impact of periurethral calcification (PUC) according to its location on uroflowmetric parameters and urinary symptoms in patients with small prostate volume (PV). METHODS: Records were obtained from a prospectively maintained database of first-visit men with lower urinary tract symptoms (LUTS). Patients whose PV was >30 mL were excluded to elucidate more clearly the impact of PUC on LUTS. A total of 539 patients were enrolled in the study. The prostatic urethra was examined by transrectal ultrasonography for PUC, and the location of PUC was divided into 3 areas (proximal, mid, and distal). RESULTS: The characteristics according to the location of PUC were compared using a 1-way analysis of variance test. The Total International Prostate Symptom Score (IPSS), postmicturition symptoms, and overactive bladder symptom score (OABSS) differed significantly among the groups. In the propensity score matching analysis, the proximal- and distal-PUC groups did not have a significantly different urinary flow rate or symptom score when compared to their matched control groups. However, the mid-PUC group had significantly worse urinary symptoms than its matched control group (total IPSS [P=0.001], voiding symptoms [P=0.002], storage symptoms [P=0.041], and OABSS [P=0.015]). The peak urinary flow rate was also lower in the mid-PUC group with borderline significance (P=0.082). On multivariate linear regression analysis, mid-PUC was independently associated with IPSS and OABSS (P=0.035 and P=0.011, respectively). CONCLUSIONS: Only mid-PUC was associated with symptom severity in men with LUTS and a small PV. Our findings suggest that mid-PUC could be a potential causal factor of LUTS, and the midportion of the prostatic urethra might play a pivotal role in the process of micturition.
Calculi ; Humans ; Inflammation ; Linear Models ; Lower Urinary Tract Symptoms* ; Male ; Propensity Score ; Prospective Studies ; Prostate* ; Prostatic Hyperplasia ; Ultrasonography ; Urethra ; Urinary Bladder, Overactive ; Urination

Spinal cord injury (SCI) may lead to urinary system disturbances. Patients with SCI usually have neurogenic bladder, and treatment optionss for this condition include clean intermittent catheterization and a permanent indwelling urethral or suprapubic catheter. Complications of catheterization include urinary tract infection, calculi, urinary tract injury, bladder contraction, bladder spasm, renal dysfunction, bladder cancer, and so forth. To the best of our knowledge, ureteral rupture is an unusual complication of catheterization, and ureteral rupture has been rarely reported in SCI patients. Therefore, here we report a case of ureteral rupture caused by a suprapubic catheter used for the treatment of neurogenic bladder with vesicoureteral reflux in a male patient with SCI. Due to SCI with neurogenic bladder, ureteral size can be reduced and the suprapubic catheter tip can easily migrate to the distal ureteral orifice. Thus, careful attention is required when a catheter is inserted into the bladder in patients with SCI.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization ; Male* ; Rupture* ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Ureter* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Catheterization ; Urinary Tract Infections ; Vesico-Ureteral Reflux

BACKGROUND/AIMS: Stones remaining after endoscopic treatment of common bile duct (CBD) stones may evolve into recurrent CBD stones or serve as nuclei for the growth of new CBD stones. The aim of the present study was to identify risk factors for the presence of residual stones after endoscopic treatment of CBD stones. METHODS: We performed a retrospective case-control study; 55 patients with residual stones were enrolled as the case group and 281 patients without such stones served as a control group. We collected information on age, sex, stone characteristics, laboratory findings, the presence/absence of a periampullary diverticulum, use of mechanical lithotripsy, use of (single-procedure) endoscopic papillary balloon dilatation (EPBD), presence/absence of multiple CBD stones, CBD stone size, CBD stone diameter, whether CBDs were associated with gall bladder stones, and histories of prior cholecystectomy and cholecystectomy performed after endoscopic treatment. RESULTS: Upon univariate analysis, mechanical lithotripsy, single-procedure EPBD, the presence of multiple CBD stones (more than four), and CBD stone diameter greater than 1 cm were risk factors for the presence of residual stones. Upon multivariate analysis, single-procedure EPBD (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.68-6.00; p = 0.000), and more than four CBD stones (OR, 2.459; 95% CI, 1.24-4.86; p = 0.010), were significant risk factors for the presence of residual stones. CONCLUSIONS: Single-procedure EPBD and the presence of more than four CBD stones were independent risk factors for the presence of residual stones. Particular care, featuring meticulous inspection, is necessary when treating patients with these risk factors. A second procedure, endoscopic retrograde cholangiopancreatography, may be required.
Bile Ducts* ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct* ; Dilatation ; Diverticulum ; Gallstones ; Humans ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Urinary Bladder Calculi

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.
Constriction, Pathologic/*diagnosis ; Humans ; Hydronephrosis/diagnosis ; Kidney/ultrasonography ; Prospective Studies ; Risk Factors ; Ureter/*pathology/ultrasonography ; Ureteral Calculi/*therapy ; Ureterolithiasis/*surgery ; Ureteroscopy/*adverse effects ; Urinary Bladder/ultrasonography