Secondary bladder stone caused by delayed penetration of the bladder by a pubic fracture: A case report and literature review

Abstract

Pelvic fractures sometimes lead to injuries of the urinary bladder, which commonly present as gross hematuria, dysuria and lower abdominal pain. As a type of urinary stone, bladder stones are usually secondary to lower urinary tract obstruction, such as benign prostatic hyperplasia, urethral stricture, and neurogenic bladder. The present case report examines an unusual case of a delayed pubic fracture penetrating the bladder, which caused a secondary bladder stone. A 53-year-old man was first hospitalized at The Second Hospital of Jiaxing (Jiaxing, China) in January 2020 because of trauma-induced bleeding in the scalp and abdominal pain. The patient underwent abdominal exploration and partial bowel resection, and his condition stabilized after surgery. After discharge, the patient had regular outpatient check-ups every 2-3 weeks. However, after 3 months, in April 2020, the patient was readmitted to the hospital because of frequent urination, an urgent need for urination and dysuria. Abdominal computed tomography imaging and cystoscopy revealed a pubic fracture that had penetrated the bladder wall, accompanied by a bladder stone. Subsequently, cystolithotomy was performed, which provided significant relief of symptoms once the catheter was removed after 2 weeks. Since then, the patient has been followed up until January 2023 and had remained asymptomatic. Bladder stones caused by necrotic bone fragmentation are rare. Bladder injuries resulting from pelvic fractures can have delayed onset; therefore, clinicians should be aware of the possibility of urogenital injury in such patients. It is crucial for clinicians to comprehend the potential mechanisms involved, analyze the clinical data of patients, closely monitor their condition and implement appropriate treatment measures when necessary.

Keywords: bladder injury; bladder stone; cystolithotomy; ischemic necrosis; pubic fracture.

Figure 1

Abdominal injuries shown by axial computed tomography images (axial view; scale bar, 10 cm). (A) Injury to the small intestine and mesentery (arrows). (B) Injury to the left inguinal area (arrow). No apparent fracture was observed in (C) pubic rami (arrow) and (D) pubic symphysis (arrow). R, right; L, left.

Figure 2

Delayed left pubic fracture was visible in the patient's computed tomography images during follow-up after discharge (axial view; scale bar, 10 cm). (A) A fracture of the left pubic bone was found 5 weeks after the injury (arrow). (B) The fragmented bone migrated closer to the bladder area at 7 weeks after the injury (arrow). R, right; L, left.

Figure 3

Left pubic fracture and secondary bladder stone observed 12 weeks after the injury. Axial computed tomography scan revealed that (A) the fragmented bone had penetrated the left anterior wall of the bladder (arrow) and (B) a stone measuring ~15x10 mm was present within the bladder (arrow) (axial view; scale bar, 10 cm). Optical images captured during the flexible cystoscopy revealed that (C) the bone fragment from the left pubis had penetrated the left anterior wall of the bladder (arrow) and (D) an osseous stone with a dark yellow color and loose consistency was discovered inside the bladder. R, right; L, left.

Figure 4

Specimen and pathological staining of the bladder stone. (A) Bladder stone specimen removed during the operation (scale bar, 5 cm). (B) Hematoxylin and eosin staining confirmed the presence of abundant eosinophilic amorphous substance, consistent with necrotic bone (magnification, x200).

Figure 5

Recovery of the bladder 7 months after the operation. Computed tomography scan showed that the left pubic bone was closely situated near the anterior wall of the bladder, without any evidence of bone fragments penetrating the bladder wall or the formation of bladder stones (arrow) (axial view; scale bar, 10 cm). R, right; L, left.