Diagnostic dilemma: Giant 'stone' in a man's bladder looked like an ostrich egg
A man visited a hospital because of bladder discomfort, and his doctors discovered a remarkably large bladder stone.
A man said he was feeling "discomfort" in his bladder. The stone pictured above was the cause. (Image credit: Nephrourol Mon. 2014 Nov 5;6(6):e20574. doi: 10.5812/numonthly.20574 (CC 4.0))
The patient: A 35-year-old man in Iran
The symptoms: The man visited a urology clinic in a hospital and described discomfort in his bladder. He had no issues with urination and no history of surgery or disease in that region of his body. Nor was he experiencing the typical symptoms of a urinary tract infection, such as feeling a constant need to urinate or having a burning sensation during urination.
What happened next: When doctors conducted a physical examination of the man's abdomen, they detected a large, smooth and solid mass above his pubis — the front of the pelvis where two pubic bones are connected by cartilage.
The dense mass wasn't attached to the pelvic area or abdominal wall, and an ultrasound scan revealed that it was an egg-shaped object about 4.3 inches (11 centimeters) in diameter, according to a report of the man's case.
The diagnosis: Physicians at the hospital identified the mass as an unusually large bladder stone. Also known as calculi, these objects grow when minerals in urine accumulate into crystals; about 85% of their makeup is calcium. They can form in the bladder when it doesn't empty fully, which causes the minerals in urine to concentrate and crystalize.
Bladder stones typically form directly in the bladder, but sometimes, they can originate from small kidney stones that migrate from the kidneys into the bladder or into the muscular tube between them, called the ureter.
The tiniest bladder stones are invisible to the naked eye, but they can vary greatly in size. Small stones typically go undetected and are passed during normal urination. However, larger stones can obstruct the flow of urine and irritate the walls of the urinary tract, and they may cause pain, interrupted urination or internal bleeding.
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The treatment: After checking to make sure the egg-like stone was not obstructing or constricting any part of the patient's urinary tract, doctors removed the stone surgically, in a procedure called a cystolithotomy. The mass was so large that they needed to extend the incision to the back of the bladder.