Rare case of gigantic phosphate stone revealed in X ray Abdomen in patient with primary hyperparathyroidism

Halimat Olaoluwa and colleagues recently published a case in Urology Case Reports called "the Andes of bladder stones" that revealed detecting massive phosphate stones on an abdomen x-ray of a 60-year-old man.

The findings suggest that the stones accumulated at a rapid rate as a result of an unusual incidence of the combined effects of primary hyperparathyroidism (PHPT) and bladder outlet blockage-two separate disorders that can cause urinary tract stone disease. There are no other examples like this one documented in the literature.

The patient had a known bladder blockage due to an enlarged prostate and reported with difficulty undergoing intermittent catheterization due to discomfort, according to the study. A later x-ray of the kidney, ureter, and bladder revealed 13 cm of radiopaque bladder stones. The "impressive bladder stones" were glaringly missing on x-ray 32 months previously, according to the authors' analysis of imaging.

A nuclear medicine sestamibi parathyroid scan also revealed increased radiotracer uptake in the right inferior parathyroid gland, supporting the diagnosis of primary hyperparathyroidism. The patient had prostatectomy, which included the removal of 254 grams of calcium phosphate bladder stones. Following that, the problematic benign parathyroid adenoma was removed.At the time of the follow-up, the patient was voiding normally and the bladder stones had been completely removed.

The transurethral minimally invasive technique using endoscopy is the chosen therapy for small volume bladder stones. A suprapubic approach, on the other hand, targets the high-volume bladder stones as well as the massive obstructing prostate, which was the source of the chronic urine retention and led to the production of bladder stones. The advantage of a laparoscopic robotic method would have been negated in this patient due to the enormous homogeneous volume of bladder stones. Because of the risk of acute renal failure due to hydronephrosis, the urology aspect was handled before the endocrine operation. Any underlying conditions must also be managed.

The authors concluded that fast buildup of bladder stones over a 30-month period in the presence of both bladder outlet blockage and PHPT is uncommon. Nonetheless, they decided that the instance demonstrates and reinforces the importance of a multidisciplinary approach to solving these complex challenges.

Reference:

Olaoluwa, H. A., Polenakovik, H., & Hakim, J. (2023). The andes of bladder stones: Gigantic bladder calculi in a patient with bladder outlet obstruction and hyperparathyroidism. In Urology Case Reports (Vol. 48, p. 102416). Elsevier BV. https://doi.org/10.1016/j.eucr.2023.102416