Early Diagnosis of a Large Vesical Calculus Complicating Pregnancy
A 23-year-old primigravida at 13 weeks of gestation presented to the antenatal clinic of the urban health center with urgency, dysuria and increased frequency of urine. On examination a mobile hard mass was felt in the right iliac fossa. On per vaginal examination a large bony mass was felt and a probable diagnosis of bladder stone complicating pregnancy was made. She was referred to the tertiary hospital where an ultrasound showed mild bilateral hydroureteronephrosis and a large vesical calculus measuring 8.3 cm causing dense acoustic shadowing obscuring the bladder base []. There was no significant post void residue. Ultrasound also confirmed the presence of a single live intra uterine fetus corresponding to the gestational age. Urine microscopy showed the presence of pus cells. Urine culture grew Enterococcus which was sensitive to Ampicillin.\nShe was referred to the urologist and underwent open cystolithotomy under spinal anesthesia. Intra operative cystoscopy revealed bladder trabeculation with stone sitting in the anterior wall of trabeculation. Two small diverticuli were seen. Right ureteric orifice was seen refluxing and pus flakes were present. On cystolithotomy a 8 × 7 cm stone was removed. Post operatively she had continuous bladder drainage for 2 weeks and was treated with appropriate antibiotics. She also received antibiotic prophylaxis till delivery. She delivered normally a live-term baby girl of Apgar 9 and 10 and birth weight 2.42 kg at 38 weeks of gestation and is on regular follow up and doing well.