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CASE REPORT
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 198-200

Recurrent urinary tract infection due to large urinary bladder calculus in a 6-year-old child


Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Submission10-Sep-2019
Date of Decision20-Jan-2020
Date of Acceptance21-Apr-2020
Date of Web Publication7-Oct-2020

Correspondence Address:
Dr. Ibrahim Haruna Gele
Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
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DOI: 10.4103/smj.smj_56_19

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  Abstract 


Urinary bladder calculus is an uncommon presentation in the tropics, especially in children. Large (>2.5 cm) or giant bladder stones are rare and are more common in males due to higher incidence of lower urinary tract obstruction. Ultrasonography and plain radiography play an important role in the diagnosis of urinary bladder stone as well as evaluation for complications that may be associated with this condition. A 6-year-old boy presented with a 3-month history of abdominal pain and dysuria. He was treated with antibiotics on several occasions in a rural health center with no satisfactory improvement of his symptoms. Ultrasound and intravenous urography showed a huge oval urinary bladder calculus measuring 4.5 cm × 4.2 cm × 4.0 cm with moderate bilateral hydronephrosis. We presented a rare case of large bladder calculus in a 6-year-old boy with recurrent urinary tract infection highlighting the role of ultrasonography and excretory urography in the management.

Keywords: Child, infection, large calculus, urinary bladder


How to cite this article:
Gele IH, Muhammad S B, Sa'idu S A, Ma'aji S M. Recurrent urinary tract infection due to large urinary bladder calculus in a 6-year-old child. Sahel Med J 2020;23:198-200

How to cite this URL:
Gele IH, Muhammad S B, Sa'idu S A, Ma'aji S M. Recurrent urinary tract infection due to large urinary bladder calculus in a 6-year-old child. Sahel Med J [serial online] 2020 [cited 2020 Oct 25];23:198-200. Available from: https://www.smjonline.org/text.asp?2020/23/3/198/297457




  Introduction Top


Urinary bladder calculus is an uncommon presentation in the tropics, especially in children.[1] It occurs as a result of stasis, infection, or foreign bodies or can descend from the kidneys. Urinary bladder calculi account for approximately 5% of all urinary system stones and are prevalent among children living in poor or rural regions.[2] Large (>2.5 cm) or giant bladder stones are rare and are more common in males due to higher incidence of lower urinary tract obstruction. These stones are usually mixed stones and are frequently associated with urinary tract infection.[3],[4]

Ultrasonography and plain radiography play an important role in the diagnosis of urinary bladder stone as well as evaluation for complications that may be associated with this condition.

This case is reported because of the large size of the urinary bladder calculus presenting in a child and more so, to emphasize the role of imaging in evaluating a patient with recurrent urinary tract infection.


  Case Report Top


BK is a 6-year-old boy who presented to the Paediatric Department of Usmanu Danfodiyo University Teaching Hospital Sokoto with a 3-month history of abdominal pain and dysuria. There was a history of urinary frequency, urgency, difficulty voiding, occasional hematuria, and fever. There was no history of passage of stone during micturition. There was no family history of bladder stone. He was treated with antibiotics on several occasions in a rural health center with no satisfactory improvement of his symptoms.

Physical examination revealed a young boy, not in painful or respiratory distress, febrile (T = 37.6°C), anicteric. There were mild bilateral renal angle tenderness and suprapubic tenderness. A hard mass was felt in the suprapubic region on palpation. A provisional diagnosis of urinary bladder calculus was made. He was referred to the Radiology Department for abdominopelvic ultrasound and plain abdominal radiography. The result of serum electrolytes showed mildly elevated blood urea (7.1 Mmol/l). Packed cell volume was normal (32%). Urinalysis showed the presence of calcium oxalate, uric acid, protein +, and blood +. Urine culture yielded the growth of  Escherichia More Details coli sensitive to amoxicillin and ciprofloxacin.

Ultrasound shows a huge oval-rounded urinary bladder calculus with posterior acoustic shadow [Figure 1] measuring 4.5 cm × 4.2 cm × 4.0 cm. The surrounding urine showed multiple mobile internal echoes. The kidneys are mildly dilated and show moderate hydronephrosis bilaterally. Plain abdominal radiograph of the abdomen and pelvis revealed a huge oval laminated radiopaque calculus in the pelvis [Figure 2]. Intravenous urography (IVU) done to further evaluate the urinary tract and function showed bilateral functioning kidneys, a large stone in the urinary bladder with moderate bilateral hydroureter, and hydronephrosis [Figure 3].
Figure 1: Ultrasound of the pelvis showing a large calculus with posterior acoustic shadowing in the urinary bladder

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Figure 2: Plain abdominal radiograph of the patient lateral and anteroposterior views showing a large calculus in the pelvis

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Figure 3: Excretory urography of the patient showing the calculus in the urinary bladder and bilateral hydronephrosis and hydroureters

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Subsequently, the patient had surgery (cystolithotomy), and the stone was removed. Intraoperative findings showed a brownish-white stone with fairly smooth surface. The urinary bladder was normal, with no mucosal ulceration or bladder diverticulum. Biochemical analysis shows the stone to compose calcium and uric acid/urate. The immediate postoperative period and follow-up visits were uneventful.


  Discussion Top


Childhood urolithiasis, especially of the bladder, is a rare occurrence.[3] Bladder stones in developing nations are more commonly endemic in children because of dehydration, infection, and low protein diet.[3] Bladder stones are usually rounded and may occur as single or multiple. They can be small or large enough to occupy the entire bladder.[2] The male-to-female ratio for bladder stone is 15:1, and the peak age of occurrence is 2–5 years. A large bladder stone is usually associated with lower urinary tract obstruction or urinary tract infection. Adedoyin et al. reported a case of bladder stone in a 3-year-old Nigerian child with posterior urethral valve.[1] There was no evidence of established lower urinary tract obstruction such as posterior urethral valve or urethral stricture in our patient that would have caused the formation of such huge calculus. Aside from the urinary tract infection, the predisposing factors that might have caused the bladder stone in this case were late presentation and possible lack of modern imaging facilities in their locality. The patient also had a poor diet which, along with reduced fluid intake, changes the chemistry of urine in the bladder and increases crystal formation. These factors probably compounded the urinary tract infection and resulted in the formation of the large calculus. This findings tally with that of Rahman et al. in Ilorin.[5]

The diagnosis of vesical calculus requires a high index of suspicion. A history of recurrent urinary tract infection with suprapubic pain that is aggravated by exercise, an interruption of the urinary stream, and terminal hematuria are helpful but not pathognomonic of vesical calculus because these symptoms may be caused by other lesions in the bladder.[6] Some of these symptoms were present in our patient.

A large bladder stone may be palpable on rectal, vaginal, or abdominal examination but is difficult to diagnose a stone through physical examination alone. Abdominal radiography, ultrasonography, IVU, and computed tomography (CT) are the most useful tools for the evaluation of children with stones.[3],[7] Plain abdominal radiograph and ultrasound are usually used as initial studies. Ultrasonography and IVU were employed in this study. Ultrasound reveals many types of stones, including some radiolucent stones, and may yield other clinically important findings such as urinary obstruction and nephrocalcinosis. Ultrasound in this case showed severe hydronephrosis and hydroureter secondary to obstruction by the bladder stone. Danfulani et al.[4] reported a case of giant bladder calculus with renal parenchymal disease in a child using ultrasound.

Bladder stones are usually single, large, rounded, and of homogeneous calcific density and thus evident on plain radiograph or on excretion urography or cystography with contrast agents. Excretion urography or IVU in addition to demonstrating the stone can show the degree of obstruction and functional (excretion) ability of the kidneys, as demonstrated in this case. However, IVU is associated with higher radiation exposure and risk due to the use of contrast agents. A recent study has suggested that nonenhanced helical CT is superior to IVU for the evaluation of urolithiasis.[3] The advantage of CT includes shorter examination time, higher sensitivity and specificity for calculi, no need for intravenous contrast, and a greater potential for making alternative diagnoses.[3]

The management of urinary bladder stone includes open cystolithotomy, extracorporeal shock wave lithotripsy, and transurethral pneumatic cystolithotripsy. The decision between endoscopic and open cystolithotomies depends on the size and number of stones. If the stones are too large or too numerous to be removed by endoscopic methods, open surgical removal may be necessary.[3],[8] Our patient had a large calculus and was removed by open cystolithotomy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patients' parents gave their consent for the clinical information to be reported in the journal. The parents understand that their names and initials will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Adedoyin OT, Adesiyun OO, Mark F, Anigilaje EA, Adeniyi A, Abdulkadir AY, et al. Bladder stone in a three-year-old Nigerian child with posterior urethral valve: A case report. West Afr J Med 2011;30:214-6.  Back to cited text no. 1
    
2.
Ozturk H, Dagistan E, Uyeturk U. A child with large bladder stone. Ped Urol Case Rep 2014;1:22-8.  Back to cited text no. 2
    
3.
Chow KS, Chou CY. A boy with a large bladder stone. Pediatr Neonatol 2008;49:150-3.  Back to cited text no. 3
    
4.
Danfulani M, Musa MA, Bashir BM. Pelvic ultrasound diagnosis of giant vesical calculus in 10 year old boy. Int J Med Res Health Sci 2014;3:1022-4.  Back to cited text no. 4
    
5.
Rahman GA, Akande AA, Mamuda NA. Giant vesical calculus: Experience with management of two Nigerians. Mg J Surg Res 2005;7:203-5.  Back to cited text no. 5
    
6.
Singal R. A rare giant bladder stone: A case report. Urotoday Int J 2010;3:1944. Available from: www.urotoday.com/volume-3-2010/vol-3-issue3/35805. [Last accessed on 2015 Sep 03].  Back to cited text no. 6
    
7.
Stapleton FB. Childhood stones. Endocrinol Metab Clin North Am 2002;31:1001-15.  Back to cited text no. 7
    
8.
Mungadi IA, Ntia IO, Opara WE, Sani AA. Urolithiasis in Sokoto, North Western Nigeria. Sahel Med J 2006;9:10-4.  Back to cited text no. 8
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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