Presentation
Patient with a history of transitional cell tumor, with bladder resection and posterior urinary diversion and neobladder. He presented to the consultation 5 years later because of hematuria.
Patient Data
A radiopaque area in right lower quadrant compatible with lithiasis.
Excretory urography, right hydronephrosis is observed, note that the right ureter is inserted very closely to the radiopaque stone in the neobladder
Correlative ultrasound: an echogenic focus is seen with posterior acoustic shadowing.
Color Doppler demonstrates posterior "color comet-tail sign". Highly suggestive finding of a stone.
Abdominal CT shows a slight dilatation of the excretory system on the right side, with distal stone immediately prior to the insertion of the neobladder, which also presents a larger internal stone.
I would like to thank Dra. Azor Mariana, of Hospital Español de Mendoza, for helping me on this case.
Case Discussion
When a patient with a history of transitional cell tumor and ileal neobladder presents with hematuria, it is important to know that there are complications of hematuria in the short and long term.
Factors to take into account we must know that:
- the risk of forming new stones at five years is ~65%
- the time of appearance of the stones is variable and can range from 6 months to several years later
Pathogenesis and etiology includes:
- Main factor: urinary stasis.
- The continuous secretory and absorptive function of the ileum and colon that contributes to the origin of lithiasis formation.
- Metabolic acidosis: loss of bicarbonate and reabsorption of urine solutes.
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