Bladder calculi presenting as complete procidentia

Multiple large bladder stones resulting in complete procidentia present unique operative challenges. A 71-year-old postmenopausal multipara was admitted to the intensive care unit for urosepsis. A firm irreducible 15 × 10 × 10 cm procidentia was noted on exam with surface erythema, erosions, and edema. A computed tomography scan of the pelvis reported a staghorn calculus in the right renal pelvis and a large calcified fibroid uterus which had prolapsed completely out of the pelvis. After resolution of her urosepsis, the patient was taken to the operating room for a vaginal hysterectomy and surgical correction of her prolapse. A small uterus weighing 67 g was identified with a large bladder mass. Cystotomy revealed multiple bladder calculi, the largest measuring 8.1 × 6.8 × 4.6 cm. Cystolithiasis should be considered when evaluating patients with large calcified prolapse.