Rare Giant Bladder Stone with the Size of an Adults' Fist in Healthy Young Male

s / Urological Science 26 (2015) S50eS81 S67 bladder prolapse. And chronic urine retention will occur. We demonstrate a rare case, who had pelvic organ prolapse for 20 years accompanied with one giant urinary bladder stone due to chronic urine retension. Materials and Methods: A 82 years old female, who had perineal protruding mass since 20 year ago. The mass was growing over time and became difficult to micturition with painful sensation while sitting. She went to our GYN OPD where pelvic organ prolapse, grade 4 was diagnosed and referred to our OPD due to hard content of urinary bladder. MRI was performed and reveals large vesical stone and bilateral hydronephrosis. Cystolithotripsy was arranged and one huge vesicle stone up to 240 gram was removed. Results: A vesical calculus in a prolapsed cystocele is rare. And the literature indicated that urinary stasis and infection may be the cause of stone formation. In our case, the pelvic organ prolapse caused the incomplete emptying of urinary bladder leading to the urinary stasis and providing the nidus and infectious environment required for stone development. Impaired renal function was also noted due to chronic urine retention and bilateral hydronephrosis. Vesicolithotripsy is indicated in this kind of patient to protect her renal function and push back the prolapsed organs. Conclusion: We present an unusual case that has long-standing pelvic organ prolapse accompanied with chronic urine retention. Huge vesicle stone formation was noted with bilateral ureteral orifice occlusion and impaired renal function. NDP067: RARE GIANT BLADDER STONE WITH THE SIZE OF AN ADULTS' FIST IN HEALTHY YOUNG MALE Tsung-Yen Lin , I-Hung Cheng , Yu-Sheng Cheng , Yung-Ming Lin . Division of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch; Department of Urology, Medical College and Hospital, National Cheng-Kung University, Tainan, Taiwan Purpose: To describe a case of giant bladder stone in healthy young male Materials and Methods: A 36-year-old male had no underlying systemic disease before. He worked at cleaning squardron and was living with his mother. He had intermittent perineum pain, difficult urination, and incontinence for many years but he only took somemedicine for pain control by himself. Hewas brought to our ER due to general malaise, weakness and severe perineum pain. Lab revealed acute renal failure (Crea 1⁄4 6.96), hyperkalemia (K 1⁄4 5.8), hyponatremia (Na 1⁄4 113), and leukocytosis (WBC 1⁄4 26500) initially. Abdominal CT revealed giant bladder stones with bilateral hydroureter and hydronephrosis. Bilateral PCN insertion was performed separately and much pus was drained out from right PCN. Bilateral antegrade pyelography was performed 6 weeks after PCN insertion and it showed persisted dilated bilateral pelvis and ureter. Cystoscopy, cystolithotomy, and suprapubic cystostomy were performed thereafter. The size of the stone was 11cm in length, 7.5cm in width, and 7cm in height, just like an adult's fist. Its weight was 520gm. Suprapubic cystostomy tube was removed smoothly after bladder training. Results: The composition of this giant bladder stone was 100% calcium phosphate. The post-operative renal function recovered gradually and serum creatinine kept below 2 in followed one year. He could urinate by himself and denied any discomfort of urination. He was back to work three months after operation. Conclusion: Most giant bladder stones were found in patients with underlying disease resulted in voiding problem or unclear conscious. It's a rare giant bladder stone in health young male. NDP068: DIAGNOSIS AND MANAGEMENT OF ESWL-INDUCED SIGNIFICANT PERIRENAL HEMATOMA Shih-Hsun Lin , Yan-Wen Zhang , Po-Huang Chiang , Wen-Chou Yang , Chun-Chien Hsu , Wei-Jing Li , Yao-Chi Chuang , Yen-Ta Chen , Yuan-Tso Cheng , Chih-Hsiung Kang . Department of Urology and Extracorporeal Shock Wave Lithotripsy, Kaohsiung, Taiwan; Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan Purpose: Extracorporeal shock wave lithotripsy (ESWL) is a well-known and highly effective treatment for removal of kidney and ureter stones. However, several complications after ESWL have been reported including renal hemorrhage. The purpose of this study is to evaluate and manage ESWL-induced perirenal hematoma in a single medical center. Materials andmethods: Seventeen patients was recognized among 15961 patients who underwent ESWL for the treatments of renal and ureteral stones by either LITE-MED Model No:LM-9200 or HMT Lithotron during 2003~2014. The stones were targeted fluoroscopically and shocks were delivered at 3000 shockwaves with ramping energy settings of 15~18 kV. The patients were found to have perirenal hematoma via abdomen computed tomography (CT) or ultrasound either at emergency room or outpatient clinic. Results: The incidence of ESWL-induced significant perirenal hematoma was 0.1%. Among the 17 patients, no one was treated for ureteral stones. Mean age was 56.2± 9 years with 14 male and 3 female. Mean stone size was 13± 8mm (range 6~37mm). All patients had flank pain on the treated-stone site, rapid pulse rate (>100bpm), and pale appearance. The mean dropped hemoglobin level was 5.8 g/dL (range 3~7.7g/dL). (From mean hemoglobin 14.8 g/dL dropped to 9.0 g/dL, p value 3 g/dL) suggested this severe complication. Rapid fluid resuscitation and blood transfusion could treat most of the patients. Arterial embolization might be necessary for the patient with potential coagulopathy.