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| Encrusted cystitis and ascites due to urethral calculus |
Tarun Jindal*( ),Satyadip Mukherjee
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| Department of Uro-oncology, Tata Medical Centre, Kolkata, India |
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Abstract A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month. He had history of straining during micturition and weak urinary stream for a year. On examination, he was disoriented and had abdominal distension. Ultrasound revealed marked ascites, pleural effusion, bilateral hydroureteronephrosis, and distended bladder with prostatic urethral calculus. A non-contrast computerized tomography scan additionally showed thickened bladder wall with florid mucosal calcification suggestive of encrusted cystitis and a 2.9 cm×2.5 cm calculus in the prostatic urethra extending to the bulbar urethra (Fig. 1). His hemoglobin was 6 g/dL; urea and creatinine were elevated (114 mg/dL and 8.4 mg/dL, respectively); and the leucocyte count was 16.3×109/L. After initial resuscitation, ultrasound guided supra-pubic catheterization was performed. The urine pH was 8.4 while the microscopy revealed numerous pus cells, bacteria, and inorganic crystals. A nephrology consultation was taken and considering the clinical picture of encrusted cystitis, he started on intravenous vancomycin. He also received a session of hemodialysis. The patient died of cardiovascular collapse on the second post admission day. The urine culture report, obtained posthumously, revealed Corynebacterium urealyticum corroborating the diagnosis of encrusted cystitis. The strain was multidrug resistant and showed only sensitivity to teicoplanin and vancomycin.
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Available online: 20 April 2022
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Corresponding Authors:
Tarun Jindal
E-mail: drtarunjindal@gmail.com
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The axial images of the computerized tomography scan of the patient showing the calcified bladder wall along with the calculus in the prostatic urethra extending to the bulbar urethra. (A and B) The extensive calcifications (arrows) of the wall of the urinary bladder along with wall thickening and ascites; (C) Calculus (arrow) in the prostatic urethra; (D) The calculus (arrow) extending into the bulbar urethra.
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