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BMJ Case Rep. 2010; 2010: bcr0620091978.
Published online Jan 13, 2010. doi:  10.1136/bcr.06.2009.1978
PMCID: PMC3028530
Images In...
Jack stone
Kai Yuen Wong and Harbinder Sharma
Bedford Hospital NHS Trust, Kempston Road, Bedford, MK42 9DJ, United Kingdom
Correspondence to Kai Yuen Wong, kaiyuen.wong/at/cantab.net
An 83-year-old man presented with frank haematuria. An abdominal x-ray showed an appearance suggestive of at least four bladder calculi with spiculated margins (fig 1). A flexible cystoscopy and subsequent open cystolithotomy was performed with removal of a dark, mobile, spiculated, 4×4×4 cm single calculus (fig 2).
Figure 1
Figure 1
Abdominal x-ray appearance suggestive of at least four bladder calculi with spiculated margins.
Figure 2
Figure 2
Dark jack stone with spiculated edges.
Bladder calculi vary in size, shape and colour. They can be single or multiple. Most are circular, but they can be almost any shape. An unusual type is the jack stone variety, which classically have a characteristic radiographic appearance and resemble toy jacks.1
Bladder calculi are usually associated with urinary stasis, which may arise from benign prostatic hypertrophy, urethral stricture, neurogenic bladder, recurrent urinary tract infections or chronic catheterisation. Presentations include abdominal pain, urinary retention and other lower urinary tract symptoms. Conversely, bladder calculi can form in a normal bladder and be asymptomatic.
The cause of frank haematuria in our patient was a bladder calculus, but it can arise from local bleeding anywhere along the urinary tract and less commonly from general causes such as bleeding diatheses. Most importantly, urological malignancies such as renal cell carcinoma and transitional cell carcinoma are common causes of frank haematuria. They need to be suspected even if another cause is found. All patients with frank haematuria require a urology referral.2 Initial investigations include blood tests and excluding transient causes, including a urinary tract infection. Further assessment includes an ultrasound scan of the urinary tract and a flexible cystoscopy.
Footnotes
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.
REFERENCES
1. Dyer RB, Chen MY, Zagoria RJ. Classic signs in uroradiology. Radiographics 2004; 24(Suppl 1): 247–80. [PubMed]
2. Renal Association and British Association of Urological Surgeons Joint consensus statement on the initial assessment of haematuria. BAUS/RA Guidelines 2008: 1–5.
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