Giant Bladder stone and rectal prolapse complication in pediatric patient: Case report and literature review

INTRODUCTION AND IMPORTANCE: A giant bladder stone (BS) in the urinary tract system with a rectal prolapse complication is a rare urologic problem; it is even rarer in pediatric patients. In the case of bladder stone formation, a variety of steps result in a variety of stone compositions. This study aims to understand the rare disease course of a one-year-old patient with bladder and urethral stones and a rectal prolapse complication. CASE PRESENTATION: A one-year-old boy presented with an inability to urinate since morning. It was a recurring incident for about a year but never resolved. The patients experienced irregular diarrhea and difficulty eating and drinking. Anal inspection revealed prolapse recti. The laboratory investigation found leukocytosis and anemia with normal blood urea nitrogen and creatinine. Urine tests revealed leukocyturia and hematuria. A plain radiograph of the abdomen showed a round opacity around the pelvic area. Ultrasonography of the abdomen and urinary tract revealed a giant BS and severe bilateral hydronephrosis. Thus, a cystolithotomy procedure was performed, and an additional urethral stone was found. Obtained bladder stones with a size of 30 × 21 × 15mm, with 57 % of uric acid and 33 % of calcium oxalate. A manual reduction of the prolapsed rectum was also performed during surgery. There was no recurrence of the prolapsed rectum after surgery. CLINICAL DISCUSSION: BS is very rare in the pediatric population. The development of our case's stone composition starts with pure uric acid, which is later enveloped by calcium oxalate due to its lack of acidic atmosphere. Rectal prolapse occurs due to increased abdominal pressure caused by straining during urination. CONCLUSION: The pathogenesis of BS is multifactorial, with local and systemic factors. Early diagnosis and comprehensive history-taking are essential for BS management decisions. The management of BS depends on its size, composition, and symptoms.