Large bladder stone in a young child, a rare case report

Large bladder stone in a young child, a rare case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Large bladder stone in a young child, a rare case report Yohannes Teshome Kassie, Worku Awoke Terunehe, Freselam Brhanu Taye, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8652459/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Bladder stone in children is a rare disease accounting for 5% of all urinary calculi and relatively more common in middle and low-income countries due to nutritional factors, poor water sanitation and warm climates. Case Presentation We present a case of large bladder stone to a 1 year and 6 months old male toddler from Afar region of Ethiopia presented with urinary frequency, urgency, dysuria and intermittent low grade fever of 5 months duration. He also cries and pulls his penis down. Otherwise, he has no remarkable medical or surgical history. At presentation, his abdomen was flat with mild suprapubic tenderness. Microscopic examination of urine shows multiple calcium oxalate crystals. Abdominal ultrasound shows about 30*24*17 millimeters sized hyperechoic, mobile mass with acoustic shadow within the urinary bladder. KUB x ray was taken and shows radiopaque elliptical body in the pelvis. Open cystolithotomy was done and about 28*22*13 millimeters sized, elliptical, hard bladder stone was removed and sent for analysis suggestive of calcium oxalate stone. On follow up till 6 months, the child had none of the possible complications nor recurrence. Clinical discussion Primary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years. Most of the case reports at these ages shows stone size less than 25 millimeters. Our case reported here is very young (1 year and 6 months) and the stone removed from him is large (28 millimeters). Conclusion Clinicians working in endemic areas should be at high index of suspicion and avoid delayed diagnosis of bladder stones for children with frequent urinary complaints at their initial visit. Bladder stone toddler Open cystolithitomy case report Figures Figure 1 Figure 2 Background Pediatric urolithiasis is an endemic disease in certain parts of the world and metabolic and environmental factors in addition to urogenital abnormalities, should be evaluated thoroughly each patient [ 1 ]. The giant bladder stone is not very common and it is usually associated with nutritional factors [ 1 ]. The oldest bladder stone found by archaeologists’ dates back to 4800 BC in Egypt [ 8 ]. Bladder stone in children is a rare disease accounting for 5% of all urinary calculi and relatively more common in middle and low-income countries due to nutritional obstacles, water sanitation, and warm climates [ 2 ]. Primary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years [ 2 ]. Traditionally, bladder stones are classified as primary, secondary and migrant [ 2 , 3 ]. Primary or endemic bladder calculi are defined as those which occur in the absence of other urinary tract pathologies [ 3 ]. The determinants for primary bladder stones are nutritional deficiencies especially that of animal protein, poor hydration mainly due to inadequate intake and recurrent diarrhea [ 2 ]. Secondary bladder stones are defined as those which occur in the presence of other urinary tract abnormalities [ 3 ]. The determinant for secondary bladder stones include conditions causing functional and mechanical bladder outlet obstruction and conditions causing recurrent urinary tract infections [ 3 ]. Migratory bladder stones are defined as those originating from the upper urinary tract [ 2 , 3 ]. Bladder calculi in children in the absence of obstruction, infection or neurogenic disease are considered to be endemic [ 8 ]. However, bladder calculi continues to be a serious public health problem in resource poor settings notably in the Middle East, Africa and South East Asia the so called Afro-Asian stone belt [ 8 ]. They are commoner in males than females, but the reason for this is unclear [ 4 ]. The clinical manifestations of bladder stones are often more subtle in children, particularly younger children, when compared with the dramatic presentation in adults, which is characterized by sudden, debilitating flank pain [ 4 , 5 ]. Among children aged 5 years and younger, symptoms such as urgency, frequency, incontinence, dysuria, pyuria and fever are noted in approximately 20 − 50% of patients [ 5 ]. Additionally, microscopic or macroscopic hematuria in children with bladder stones has been noted in 33–90% of patients [ 5 ]. Most bladder stones are composed of calcium oxalate (45–65%), followed by calcium phosphate (14–30%), and they are usually larger than 2.5 cm in diameter [ 5 ]. Aetiology and mechanism of endemic stones are presumed to be multifactorial, but remain unclear [ 6 ]. Higher prevalence of stone disease is more commonly found in hot, arid or dry climate areas like mountains, desert or tropical area [ 6 , 7 ]. Malnourished children with low body mass index (BMI) are more prone to develop bladder stones [ 6 ]. In developing countries like Thailand, India, and Pakistan an association between childhood bladder stone and famine, drought and vegetarian diet has been documented, a link supported by a dramatic decline in prevalence with improvement in child nutritional status [ 6 ]. Although open cystolithotomy is the traditionally accepted treatment modality, minimally invasive treatments have widely been adopted to reduce hospital stay and convalescence [ 7 , 8 ]. However, it is unclear whether these treatments may compromise stone-free rates (SFRs) and what morbidity they may expose patients to [ 9 ]. In addition, percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children [ 10 ]. Herein, we present a toddler with a large urinary bladder stone. Methods This work has been reported in line with the SCARE guideline criterion [ 11 ]. Case Presentation A 1 year and 6 months old male toddler from Afar region of Ethiopia presented with urinary frequency, urgency, dysuria and intermittent low grade fever of 5 months duration. He usually cries and pulls his penis down when he feels those urinary difficulties. He was frequently treated at nearby health center with antibiotics but got no significant improvement. Otherwise, he has no remarkable known self or family history of medical or surgical condition. At presentation, he was well looking with stable vital signs. His abdomen was flat with mild suprapubic tenderness. He has well formed male external genitalia. He was investigated with CBC and RFT which were all normal. Microscopic examination of urine shows multiple calcium oxalate crystals. Abdominal ultrasound shows about 30*24*17 millimeters sized hyperechoic, mobile mass with acoustic shadow within the urinary bladder suggestive of bladder stone. KUB x ray was taken and shows radiopaque elliptical body in the pelvis (Fig. 1 ). After informed and written consent was taken, open cystolithotomy was done and about 28*22*13 millimeters sized, elliptical, hard bladder stone was removed (Fig. 2 ). The patient had smooth post operative course and discharged on third day after surgery. The calculi was sent for analysis and suggestive of calcium oxalate stone without any bacterial or epithelial cells. On follow up after a week, one month and six months after the surgery, the child had none of the possible complications, able to void clear urine and follow up urine analysis and abdominal ultrasound were unremarkable. Discussion Bladder stones in developing nations are more commonly endemic in children because of dehydration, infection and a low-protein diet [ 1 ]. In endemic areas, the calculi are seen frequently in children and do not exist with other anomalies [ 2 ]. The disease is much more common in boys than in girls, with ratios ranging from 9:1 to as high as 33:1 [ 2 ]. The determinants for primary bladder stones are nutritional deficiencies especially that of animal protein and poor hydration mainly due to inadequate intake and recurrent diarrhea [ 3 ]. Our case is a male child who lives in desert area (Afar region of Ethiopia) where there is significant shortage of water. He also developed the bladder stone without any identified cause of urinary obstruction, infection or cause of urine stasis. Based on a report from Taiwan, the peak age for occurrence is 2 − 5 years but there is a 1 year and 2 months old toddler with 19*13 millimeters sized bladder stone reported from Indonesia [ 2 , 4 ]. This case is only 1 year and 6 months old male toddler with 28*22*13 millimeters sized bladder stone (Fig. 2 ) which is very large for this age among the reported cases. The symptoms and findings in children with bladder stones are usually urgency, frequency, incontinence, dysuria, pyuria, difficulty voiding, small caliber of urinary stream, lower abdominal pain and urinary intermittency. Pulling the penis, in children, is considered pathognomonic of bladder stone [ 2 , 4 , 5 , 6 ]. The case reported here had almost all of these symptoms including the the pathognomonic feature. Pre-operative work-up was focused to rule out any possible anatomical malformations of the entire urinary tract and their functional implications [ 7 ]. Investigations included CBC, urine analysis, RFT, ultrasonography and plain abdominal radiograph [ 7 , 10 ]. All those investigations were done to our case which shown calcium oxalate crystals in his urine and bladder stone through the imagings but ruled out any hydronephrosis, renal failure or any sonographically detectable anatomic abnormalities. From the technical point of view, the best advanced option is endourological approach, an operative cystoscope with a variable diameter according to the patient’s age and nature of the stones using a Holmium laser fiber with a core size of 270 µm or less [ 7 , 8 , 9 , 10 ]. We did open cystolithotomy because of lack of those endourologic materials for children but after follow up for about 6 months, our case got significant improvement and had non of the possible complications except the scar at the suprapubic area. Conclusion Children who live in endemic areas are more likely to develop bladder stones due to dietary issues, inadequate hydration and urinary tract infections. Clinicians working in such endemic areas should be at high index of suspicion and avoid delayed diagnosis of bladder stones for children with frequent urinary complaints during their initial visit. Abbreviations BC Before Christ BMI body mass index CBC Complete blood count KUB Kidney ureter bladder RFT renal function test SCARE Surgical case report SFR stone free rate WMA World Medical Association µm micrometer. Declarations Acknowledgements Not applicable. Authors’ contributions Conceptualization: YT,WA. Data collection and Methodology development: YT, WA Software: YT. Data analysis: YT,WA. Manuscript Draft: YT,WA. Manuscript review and editing; YT,WA,AF,AS,FB,WD. All authors have read and approved the manuscript. Ethical approval All procedures performed in this study involving human participants were in accordance with the declaration of Helsinki developed by The World Medical Association (WMA) and the ethical standards of the institutional and national research committee. Consent for publication Informed consent was obtained from the child’s parents for this study. Competing interests Authors declare that they have no competing interests. Funding The authors received no financial support for the publication and/or authorship of this article. Clinical trial registration number Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from corresponding authors on reasonable request. References Ali SS, Mukhopadhyay NN, Bhar P, Sarkar NN. Giant bladder stone in children. J Pediatr Surg Case Rep. 2022;77:102164. Sanjaya IG, De Niro AJ, Paramitha AA. Bladder stone in a 1-year infant with recurrent urinary tract infections: a rare case report. Intisari Sains Medis. 2023;14(2):590–4. Ngugi PM, Kahie AA, Ndaguatha PL, Osawa FO, Kagiri S, Opondo D, Kisumu K, Mugallo E, Musau P, Mburugu P, Matu J. Kenya Journal of Urology. Chow KS, Chou CY. A boy with a large bladder stone. Pediatr Neonatology. 2008;49(4):150–3. Ozturk H, Dagistan E, Uyeturk U. A child with a large bladder stone: A case report. Ped Urol Case Rep. 2014;1(4):22–8. Lal B, Paryani JP. Childhood bladder stones-an endemic disease of developing countries. J Ayub Med Coll Abbottabad. 2015;27(1):17–21. Esposito C, Autorino G, Masieri L, Castagnetti M, Del Conte F, Coppola V, Cerulo M, Crocetto F, Escolino M. Minimally invasive management of bladder stones in children. Front Pead. 2021;8:618756. Hatroom AA, Ahmed A. Bladder stone disease in children: clinical study in Aden, Yemen. World Family Medicine. 2020 Jan 1. Donaldson JF, Ruhayel Y, Skolarikos A, MacLennan S, Yuan Y, Shepherd R, Thomas K, Seitz C, Petrik A, Türk C, Neisius A. Treatment of bladder stones in adults and children: a systematic review and meta-analysis on behalf of the European Association of Urology Urolithiasis Guideline Panel. Eur Urol. 2019;76(3):352–67. Salah MA, Holman E, Tóth C. Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country. Eur Urol. 2001;39(4):466–70. Kerwan A, Al-Jabir A, Mathew G, Sohrabi C, Rashid R, Franchi T, Nicola M, Agha M, Agha RA. Revised Surgical CAse REport (SCARE) guideline: An update for the age of Artificial Intelligence. Premier J Sci 2025:10100079. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8652459","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":578063637,"identity":"2b8f440e-aaea-483b-8b93-1475aee0eba2","order_by":0,"name":"Yohannes Teshome 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07:11:07","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40089,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8652459/v1/df01ab55198d3922dc5f9f85.html"},{"id":100947147,"identity":"7833085c-138e-4700-a455-5b31e80627ae","added_by":"auto","created_at":"2026-01-23 06:27:08","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28953,"visible":true,"origin":"","legend":"\u003cp\u003eAbdominal x ray of the patient showing radiopaque elliptical body in the pelvis.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8652459/v1/7ffebb0b7447ec19c60cd007.jpeg"},{"id":100951003,"identity":"1959f7f3-c295-433d-a6d9-25d80c61563a","added_by":"auto","created_at":"2026-01-23 07:09:49","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":445298,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative picture of the bladder stone (a) and the stone after the blood was removed (b).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8652459/v1/4e2399c26ef6adddbfe02d7d.jpeg"},{"id":101204133,"identity":"e51f74df-786a-4508-989e-740c08334d40","added_by":"auto","created_at":"2026-01-27 09:41:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883104,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8652459/v1/a09ceb4e-146f-48ca-bba3-0ce761d89108.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Large bladder stone in a young child, a rare case report","fulltext":[{"header":"Background","content":"\u003cp\u003ePediatric urolithiasis is an endemic disease in certain parts of the world and metabolic and environmental factors in addition to urogenital abnormalities, should be evaluated thoroughly each patient [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The giant bladder stone is not very common and it is usually associated with nutritional factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The oldest bladder stone found by archaeologists\u0026rsquo; dates back to 4800 BC in Egypt [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Bladder stone in children is a rare disease accounting for 5% of all urinary calculi and relatively more common in middle and low-income countries due to nutritional obstacles, water sanitation, and warm climates [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Primary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditionally, bladder stones are classified as primary, secondary and migrant [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Primary or endemic bladder calculi are defined as those which occur in the absence of other urinary tract pathologies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The determinants for primary bladder stones are nutritional deficiencies especially that of animal protein, poor hydration mainly due to inadequate intake and recurrent diarrhea [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Secondary bladder stones are defined as those which occur in the presence of other urinary tract abnormalities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The determinant for secondary bladder stones include conditions causing functional and mechanical bladder outlet obstruction and conditions causing recurrent urinary tract infections [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Migratory bladder stones are defined as those originating from the upper urinary tract [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Bladder calculi in children in the absence of obstruction, infection or neurogenic disease are considered to be endemic [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, bladder calculi continues to be a serious public health problem in resource poor settings notably in the Middle East, Africa and South East Asia the so called Afro-Asian stone belt [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThey are commoner in males than females, but the reason for this is unclear [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The clinical manifestations of bladder stones are often more subtle in children, particularly younger children, when compared with the dramatic presentation in adults, which is characterized by sudden, debilitating flank pain [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Among children aged 5 years and younger, symptoms such as urgency, frequency, incontinence, dysuria, pyuria and fever are noted in approximately 20\u0026thinsp;\u0026minus;\u0026thinsp;50% of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, microscopic or macroscopic hematuria in children with bladder stones has been noted in 33\u0026ndash;90% of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Most bladder stones are composed of calcium oxalate (45\u0026ndash;65%), followed by calcium phosphate (14\u0026ndash;30%), and they are usually larger than 2.5 cm in diameter [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAetiology and mechanism of endemic stones are presumed to be multifactorial, but remain unclear [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Higher prevalence of stone disease is more commonly found in hot, arid or dry climate areas like mountains, desert or tropical area [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Malnourished children with low body mass index (BMI) are more prone to develop bladder stones [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In developing countries like Thailand, India, and Pakistan an association between childhood bladder stone and famine, drought and vegetarian diet has been documented, a link supported by a dramatic decline in prevalence with improvement in child nutritional status [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough open cystolithotomy is the traditionally accepted treatment modality, minimally invasive treatments have widely been adopted to reduce hospital stay and convalescence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, it is unclear whether these treatments may compromise stone-free rates (SFRs) and what morbidity they may expose patients to [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition, percutaneous suprapubic lithotripsy is a safe and effective method for the treatment of bladder stones in children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHerein, we present a toddler with a large urinary bladder stone.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis work has been reported in line with the SCARE guideline criterion [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 1 year and 6 months old male toddler from Afar region of Ethiopia presented with urinary frequency, urgency, dysuria and intermittent low grade fever of 5 months duration. He usually cries and pulls his penis down when he feels those urinary difficulties. He was frequently treated at nearby health center with antibiotics but got no significant improvement. Otherwise, he has no remarkable known self or family history of medical or surgical condition. At presentation, he was well looking with stable vital signs. His abdomen was flat with mild suprapubic tenderness. He has well formed male external genitalia. He was investigated with CBC and RFT which were all normal. Microscopic examination of urine shows multiple calcium oxalate crystals. Abdominal ultrasound shows about 30*24*17 millimeters sized hyperechoic, mobile mass with acoustic shadow within the urinary bladder suggestive of bladder stone. KUB x ray was taken and shows radiopaque elliptical body in the pelvis\u003c/p\u003e\u003cp\u003e(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). After informed and written consent was taken, open cystolithotomy was done and about 28*22*13 millimeters sized, elliptical, hard bladder stone was removed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The patient had smooth post operative course and discharged on third day after surgery. The calculi was sent for analysis and suggestive of calcium oxalate stone without any bacterial or epithelial cells. On follow up after a week, one month and six months after the surgery, the child had none of the possible complications, able to void clear urine and follow up urine analysis and abdominal ultrasound were unremarkable.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBladder stones in developing nations are more commonly endemic in children because of dehydration, infection and a low-protein diet [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In endemic areas, the calculi are seen frequently in children and do not exist with other anomalies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The disease is much more common in boys than in girls, with ratios ranging from 9:1 to as high as 33:1 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The determinants for primary bladder stones are nutritional deficiencies especially that of animal protein and poor hydration mainly due to inadequate intake and recurrent diarrhea [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Our case is a male child who lives in desert area (Afar region of Ethiopia) where there is significant shortage of water. He also developed the bladder stone without any identified cause of urinary obstruction, infection or cause of urine stasis.\u003c/p\u003e \u003cp\u003eBased on a report from Taiwan, the peak age for occurrence is 2\u0026thinsp;\u0026minus;\u0026thinsp;5 years but there is a 1 year and 2 months old toddler with 19*13 millimeters sized bladder stone reported from Indonesia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This case is only 1 year and 6 months old male toddler with 28*22*13 millimeters sized bladder stone (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) which is very large for this age among the reported cases.\u003c/p\u003e \u003cp\u003eThe symptoms and findings in children with bladder stones are usually urgency, frequency, incontinence, dysuria, pyuria, difficulty voiding, small caliber of urinary stream, lower abdominal pain and urinary intermittency. Pulling the penis, in children, is considered pathognomonic of bladder stone [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The case reported here had almost all of these symptoms including the the pathognomonic feature.\u003c/p\u003e \u003cp\u003ePre-operative work-up was focused to rule out any possible anatomical malformations of the entire urinary tract and their functional implications [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Investigations included CBC, urine analysis, RFT, ultrasonography and plain abdominal radiograph [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. All those investigations were done to our case which shown calcium oxalate crystals in his urine and bladder stone through the imagings but ruled out any hydronephrosis, renal failure or any sonographically detectable anatomic abnormalities.\u003c/p\u003e \u003cp\u003eFrom the technical point of view, the best advanced option is endourological approach, an operative cystoscope with a variable diameter according to the patient\u0026rsquo;s age and nature of the stones using a Holmium laser fiber with a core size of 270 \u0026micro;m or less [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. We did open cystolithotomy because of lack of those endourologic materials for children but after follow up for about 6 months, our case got significant improvement and had non of the possible complications except the scar at the suprapubic area.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eChildren who live in endemic areas are more likely to develop bladder stones due to dietary issues, inadequate hydration and urinary tract infections. Clinicians working in such endemic areas should be at high index of suspicion and avoid delayed diagnosis of bladder stones for children with frequent urinary complaints during their initial visit.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBefore Christ\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplete blood count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKUB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKidney ureter bladder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRFT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erenal function test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCARE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgical case report\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estone free rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWorld Medical Association\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026micro;m\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emicrometer.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: YT,WA. Data collection and Methodology development: YT, WA\u003c/p\u003e\n\u003cp\u003eSoftware: YT. Data analysis: YT,WA. Manuscript Draft: YT,WA. Manuscript review and editing; YT,WA,AF,AS,FB,WD. All authors have read and approved the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study involving human participants were in accordance with the\u0026nbsp;declaration of Helsinki developed by The World Medical Association (WMA) and\u0026nbsp;the ethical standards of the institutional and national research committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the child\u0026rsquo;s parents for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the publication and/or authorship of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from corresponding authors on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAli SS, Mukhopadhyay NN, Bhar P, Sarkar NN. Giant bladder stone in children. J Pediatr Surg Case Rep. 2022;77:102164.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanjaya IG, De Niro AJ, Paramitha AA. Bladder stone in a 1-year infant with recurrent urinary tract infections: a rare case report. Intisari Sains Medis. 2023;14(2):590\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNgugi PM, Kahie AA, Ndaguatha PL, Osawa FO, Kagiri S, Opondo D, Kisumu K, Mugallo E, Musau P, Mburugu P, Matu J. Kenya Journal of Urology.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChow KS, Chou CY. A boy with a large bladder stone. Pediatr Neonatology. 2008;49(4):150\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzturk H, Dagistan E, Uyeturk U. A child with a large bladder stone: A case report. Ped Urol Case Rep. 2014;1(4):22\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLal B, Paryani JP. Childhood bladder stones-an endemic disease of developing countries. J Ayub Med Coll Abbottabad. 2015;27(1):17\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsposito C, Autorino G, Masieri L, Castagnetti M, Del Conte F, Coppola V, Cerulo M, Crocetto F, Escolino M. Minimally invasive management of bladder stones in children. Front Pead. 2021;8:618756.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHatroom AA, Ahmed A. Bladder stone disease in children: clinical study in Aden, Yemen. World Family Medicine. 2020 Jan 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonaldson JF, Ruhayel Y, Skolarikos A, MacLennan S, Yuan Y, Shepherd R, Thomas K, Seitz C, Petrik A, T\u0026uuml;rk C, Neisius A. Treatment of bladder stones in adults and children: a systematic review and meta-analysis on behalf of the European Association of Urology Urolithiasis Guideline Panel. Eur Urol. 2019;76(3):352\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalah MA, Holman E, T\u0026oacute;th C. Percutaneous suprapubic cystolithotripsy for pediatric bladder stones in a developing country. Eur Urol. 2001;39(4):466\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerwan A, Al-Jabir A, Mathew G, Sohrabi C, Rashid R, Franchi T, Nicola M, Agha M, Agha RA. Revised Surgical CAse REport (SCARE) guideline: An update for the age of Artificial Intelligence. Premier J Sci 2025:10100079.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bladder stone, toddler, Open cystolithitomy, case report","lastPublishedDoi":"10.21203/rs.3.rs-8652459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8652459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBladder stone in children is a rare disease accounting for 5% of all urinary calculi and relatively more common in middle and low-income countries due to nutritional factors, poor water sanitation and warm climates.\u003c/p\u003e\u003ch2\u003eCase Presentation\u003c/h2\u003e \u003cp\u003eWe present a case of large bladder stone to a 1 year and 6 months old male toddler from Afar region of Ethiopia presented with urinary frequency, urgency, dysuria and intermittent low grade fever of 5 months duration. He also cries and pulls his penis down. Otherwise, he has no remarkable medical or surgical history. At presentation, his abdomen was flat with mild suprapubic tenderness. Microscopic examination of urine shows multiple calcium oxalate crystals. Abdominal ultrasound shows about 30*24*17 millimeters sized hyperechoic, mobile mass with acoustic shadow within the urinary bladder. KUB x ray was taken and shows radiopaque elliptical body in the pelvis. Open cystolithotomy was done and about 28*22*13 millimeters sized, elliptical, hard bladder stone was removed and sent for analysis suggestive of calcium oxalate stone. On follow up till 6 months, the child had none of the possible complications nor recurrence.\u003c/p\u003e\u003ch2\u003eClinical discussion\u003c/h2\u003e \u003cp\u003ePrimary bladder calculi are most common in children younger than 10 years old, with a peak incidence at 2 to 4 years. Most of the case reports at these ages shows stone size less than 25 millimeters. Our case reported here is very young (1 year and 6 months) and the stone removed from him is large (28 millimeters).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eClinicians working in endemic areas should be at high index of suspicion and avoid delayed diagnosis of bladder stones for children with frequent urinary complaints at their initial visit.\u003c/p\u003e","manuscriptTitle":"Large bladder stone in a young child, a rare case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 06:27:02","doi":"10.21203/rs.3.rs-8652459/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95e1400d-375d-41cc-b9ff-dadada59b5b0","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T05:07:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 06:27:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8652459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8652459","identity":"rs-8652459","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}