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On day 20 of admission the child developed self-limiting paralytic ileus which was managed
conservatively with nasal gastric tube and intravenous fluids {Ringers lactate}. Upon the child
condition stabilising he was taken for Transvesical Cystolithotomy in which two bladder stones were
extracted, one impacted in the bladder neck size 4x4cm.
Figure 1
Figure2
Figure 3
Outcome
At post operative period the child developed post obstructive diuresis up to 4200ml/day. There was
subsequent dramatic improvement in renal function. Serum creatinine dropped to 109umol/l. He
was discharged to be followed up in the clinic on 20th postoperative day with good urinary stream
out put and mild occasional urinary incontinence.
Figure 4
renal support treatment, correct acidosis and look out for post obstructive diuresis in the postoperative period. Surgical intervention by open Cyst lithotomy or endoscopic Cystolithotomy can
achieve satisfactory results [9]. It is advisable to manage patients in cooperation with nephrologists.
Efforts must made to investigate the primary cause of repeated urinary tract infections through
radiological investigations like plain x-ray KUB and ultrasonography in patients with voiding
problems[ 10].
Conclusion
Bladder stone if large enough or if impacted in the bladder neck can cause obstructive uropathy
leading to renal failure. Recurrent urinary tract infections should be adequately evaluated with
radiological investigations for early and prompt diagnosis of the cause.
References
1. Daeschner C.W, Single J.C.C [1960], Urinary Tract Calculi and Nephrocalcinosis in infants and
Children .Vol.57 Issues pages 721-732
2. Sundaram CP, Houshiar AM, Reddy PK. [1997], Bladder stone causing renal failure. Minn Med.
Sep; 80(9): 25-6.
3. Dorairajan L.N, Talmer & Hemal A.K [2001), Stone Neclace of Urinary tract presenting as renal
Failure.
4. Aurora A.L, Taneja O.P, Gupta D>N [2008] Bladder Stone Disease of Childhood; An
Epidemiological Study.
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*
5. Fadi Kamal, MD, Aaron T.D. Clark, MD, Luke Thomas Lavalle, BSc, Matthew
Roberts, MD,* and James Watterson, MD* Intravesical foreign bodyinduced bladder calculi
resulting in obstructive renal failure
6. Wuran Wei1 and Jia Wang [2009] A huge bladder calculus causing acute renal failure, urological
research.
7
S. Madjar1, B. Moskovitz1, A. Kastin1, M. Stein1 and O. Nativ [1996], Anuria and acute renal
failure caused by multiple bladder calculi
8. Wuhan W. Harvard Medical School, Large bladder causing hydronephrosis.
9
10. Joshi B R, Shrestha PM Can Urinary Bladder Stones Cause Renal Failure?