Bladder Stone

dok_zlo — 09.01.2025

A 72-year-old woman with a 30-year history of high thoracic paraplegia was referred to the urology clinic for treatment of a bladder stone. Owing to neurogenic bladder, the patient had a long-term indwelling urethral catheter. Two months before presentation, she had started having intermittently bloody urine. An abdominal ultrasound had identified a bladder stone at that time. Physical examination was notable for mild tenderness and a palpable mass in the suprapubic region. Urinalysis showed considerable pyuria, as well as hematuria, nitrites, and protein. A urine culture grew Escherichia coli and Morganella morganii; antibacterial agents were used to clear these bacteria before the planned extraction procedure. Computed tomography of the abdomen revealed a layered bladder stone measuring 6 cm×8 cm×9 cm, as well as multiple bladder diverticula. Some bladder stones form tree ring–like layers owing to episodic variations in mineral deposition and urine composition over time. Long-term use of an indwelling catheter and urinary stasis from neurogenic lower urinary tract dysfunction and bladder diverticula are risk factors for bladder-stone formation. Transurethral holmium laser lithotripsy and stone extraction were performed. No stone analysis was conducted. At 1 month of follow-up, the patient’s symptoms had resolved.
Authors: Zihao Li, B.Med. , and Zhao Li, B.Med.
Published January 4, 2025
N Engl J Med 2025;392: e8
DOI: 10.1056/NEJMicm2411456
VOL. 392 NO. 2

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