1027Vol. 10    |    No. 4    |    Autumn 2013    |U R O LO G Y   J O U R N A L

Urology Department, IRCCS Poli-
clinico San Donato, University 
of Milan, Via Morandi 30, 20097, 
San Donato Milanese, Milan, 
Italy.

* E-mail: stepico@tin.it

A 64-year old patient presented in hospital with abdominal discomfort. Seven years before the patient had undergone radical cystectomy for invasive bladder cancer with orthotopic bladder reconstruction. A large medial hernia and two solid masses 
that rub together were palpated in the lower abdomen. A computed tomography (CT) scan of 
abdomen shows into the neo-bladder two big stone formations of 6 cm and 9 cm (Figure 1). 
He underwent to a median suprapubic neo-cystolithotomy (Figure 2). The most common long 
term complications in patients with ileal neobladder are metabolic acidosis, chronic urine 
retention, hernia and stone formation in the upper and lower urinary tract. In patients with 
adequate follow-up, stones can be identified and removed before they cause major symptoms. 
Symptomatology is often very subtle and nonspecific but commonly presents with irritative 
lower urinary tract symptoms, pain and hematuria. For this reason, in some cases the stone 
can become quite large without the patient being aware. Surgery is currently the gold standard 
of care and, depending on the size of the stone, we can use either trans-urethral lithotripsy or 
cystolithotomy.

Stefano Picozzi, Alberto Macchi, Luca Carmignani

Giant Bladder Stones
PICTORIAL  UROLOGY

Figure 1. A computed tomography (CT) scan of abdomen 
shows into the neo-bladder two big stone measuring 6 
and 9 cm.

Figure 2. The removed neobladder stones during neo-
cystolithotomy.