Mr. Ngoc arrived at Tam Anh General Hospital, TP HCM, for treatment of an abdominal aortic aneurysm and bilateral femoral artery occlusion. During his treatment, an X-ray revealed a very large bladder stone, measuring 75x70x50 mm, which was compressing his urethra and bladder wall.

Mr. Ngoc stated he was diagnosed with a bladder stone 10 years ago but did not undergo surgery, opting only for medication. Over the past year, he experienced continuous urinary retention, painful and intermittent urination, cloudy, dark, foul-smelling urine, sometimes with blood, along with dull pain in his lower abdomen.

Doctor Pham The Anh, from the Urology Department at the Urology - Nephrology - Andrology Center, determined that the large, hard stone made lithotripsy ineffective. Attempting lithotripsy on such a large stone could release bacteria into the bloodstream, potentially causing septic shock. The team decided on open surgery to remove the entire stone from the patient's bladder quickly and safely.

Doctor The Anh (center) and the surgical team remove Mr. Ngoc's bladder stone. *Photo: Tam Anh General Hospital*

The open surgery posed significant challenges for the team due to Mr. Ngoc's history of high blood pressure and diabetes. He had previously received two coronary stents and an abdominal aortic stent graft. The surgeons had to operate with precision to avoid touching the femoral artery bypass graft system, which had just been established by the Thoracic and Vascular Surgery team. "A minor error damaging the bypass could nullify all previous surgical efforts, putting the patient in a dangerous situation," Doctor The Anh explained.

The team carefully made a sufficient incision in the lower abdomen to remove the stone, avoiding damage to the peritoneum. They lifted the stone from the bladder without tearing the bladder lining or causing massive bleeding from pelvic blood vessels. Finally, the doctors meticulously sutured the tissue layers, ensuring a tight closure to prevent urine leakage and postoperative infection.

After two hours of surgery, one and a half times longer than normal due to the stone's size, the entire stone was removed. It was rock-hard and the size of an adult's fist.

Doctors also took a bladder tissue sample for histopathological examination. The pathological results revealed Mr. Ngoc had invasive squamous cell carcinoma, a complication caused by the long-term presence of the stone. Post-surgery, Mr. Ngoc no longer experienced abdominal pain and continues to receive postoperative monitoring, with his health condition stable enough for the next stage of cancer treatment.

The fist-sized stone removed from the patient's bladder. *Photo: Tam Anh General Hospital*

Bladder stones, when accumulated over time, cause pain and infection, and also carry a risk of cancer due to chronic irritation of the bladder lining. Doctors advise patients who discover stones to seek specialized medical examination for early treatment. Less invasive methods such as extracorporeal lithotripsy, retrograde intrarenal surgery (RIRS) with laser lithotripsy, or percutaneous nephrolithotomy (PCNL) via a mini-tract can reduce pain, shorten recovery time, and limit complications. Delaying treatment allows stones to grow larger, forcing patients to face more complex major surgeries.

Bao Anh

*Patient's name has been changed