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In a rare surgery, doctors at Indian Spinal Injury Center (ISC) in Delhi removed 16 stones weighing 500 gms from a 29-year-old paralyzed (paraplegic) man's bladder this month.
Deepak, a resident of Morena in Madhya Pradesh, had a spine injury two years ago when he fell from the terrace of his house. He had sustained a spine injury during the fall in the form of a compression fracture at the D12 spine level. He was under treatment at ISIC for the same when he was referred to Dr HS Chhabra for treatment and rehabilitation purposes. Deepak was undergoing rehabilitation when he was evaluated for having urinary problems as well. A scan by Dr Prashant Jain at a Private hospital and his team revealed that the bladder was having 16 stones and they were of good size. "In all paraplegic patients, there are lower urinary tract infections, where the bladder and bowel are involved. His bladder was also not functioning well, and he had to put a catheter into that. We call it a secondary neurogenic bladder. When he came to us, his case had reference to the urology department as well. When I examined him, he had many stones in the bladder which were silently growing," said Dr Prashant Jain consultant & surgeon at Urology & Andrology department at ISIC, New Delhi. "After X-ray, we got a CT scan also done along with other investigations which revealed the presence of stones in the bladder," he added. Dr Prashant Jain further said that luckily the patient had no stones in the kidney and his kidney functions were also good. "There are two ways of removing the stones from a bladder, but it was a small capacity bladder, not very big capacity. At the same time, there was infection and stones. So, we counselled the patient and then decided to remove the stones in one go only by open cystolithotomy procedure," he stated. "The procedure was done in OT under general anaesthesia. The patient did very well after the surgery. We removed the stones through a small hole in the bladder which was made in the suprapubic area. All stones were removed in one and then the bladder and wound were repaired. The patient is on to complete recovery now," he further stated. According to Dr Prashant Jain consultant of Urology & andrology, neurogenic bladders are more prone to small capacity bladder infections and bladder stones. The problem is common in most paraplegic patients as their bladder is not naturally working, he said. The bladder works as a storage unit in the body and at the same time as an evacuating organ for the urine. "In case of paraplegic patients who have neurogenic bladder, they store the urine but do not empty it out. So, the sediment of the urine keeps collecting inside the bladder and with the flow of urine, that sediment keeps churning and ultimately it forms solid stones in the bladder. So, infections of bladder and bladder stones and other infections are more common in the neurogenic bladder," he said. Neurogenic bladder is a term applied to urinary bladder malfunction due to neurologic dysfunction emanating from internal or external trauma, disease, or injury. (ANI)
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