Neglected giant bladder stone with bilateral ureteral stones: A case report of staged surgical treatment

Introduction and importance: A giant bladder stone is a rare urological condition in which a massive stone forms due to various contributing factors. We present a rare case of a giant bladder stone with concurrent ureteral stones, detailing its staged surgical management and relevant literature. Case presentation: A 44-year-old male presented with right flank, left flank, and suprapubic pain for one month prior to admission, accompanied by dysuria and a history of stones passage through the urinary tract. On examination, the patient presented with suprapubic pain, and laboratory results revealed severe anemia with elevated blood urea nitrogen (BUN) and serum creatinine levels. A vesicolithotomy was performed, followed by ureteroscopic lithotripsy (URS) one month later. A 15 x 10 cm bladder stone was found during the first surgery, and multiple ureteral stones were discovered during the second surgery. After surgery, the patient improved BUN (93.5 mg/dL to 27.6 mg/dL), serum creatinine (8.11 mg/dL to 1.85 mg/dL), and reduced flank and suprapubic pain. Clinical discussion: The management of giant bladder stones involves open vesicolithotomy, which is considered the gold standard for complete removal, as AUA and EAU guidelines recommend. A subsequent URS for the removal of bilateral ureteral stones provides a favorable outcome for the patient. Conclusion: A holistic approach for giant bladder stones is required, encompassing diagnosis and surgical planning to minimize misdiagnosis and complications. A staged surgical approach, including vesicolithotomy and ureteroscopic lithotripsy, may be beneficial.