title: Initial presentation in psychiatry emergency room led to diagnosis of many urinary bladder stones in a male patient.
abstract: The first case of man who presented to psychiatry emergency room for evaluation of abnormal behavior because of urinary stones was reported. Careful evaluation of patient led to a diagnosis of 37 urinary bladder stones in an Egyptian man with obstructive uropathy and metabolic defects in the form of hyperoxaluria and hypocitraturia. Knowledge of the differential diagnosis of metabolic defects can lead to successful outcome in preventing reformation of urinary tract stones after surgery. A 61-year-old Egyptian man presented to psychiatry emergency room because he was found lying on floor in bathroom to urinate by his wife who thought her husband needed psychiatric evaluation. Patient gave history of frequent urination and dysuria on and off for 3 years. In the last 3 months before his presentation to emergency room, he got into a habit of lying down on his left side when he went to bathroom to urinate because it was easier for him to pass urine. Renal consultation requested because of presence of red blood cells in urinalysis. Computed tomography of the abdomen and pelvis showed bilateral hydronephrosis and multiple bladder stones. Twenty-four-hour urine collection showed low urinary citrate and high oxalate. Patient underwent open vesicolithotomy and removal of 36 stones. Stone analysis showed 75% uric acid and 25% calcium oxalate. Patient did very well after surgery, and 1 month later, he underwent transuretheral resection of prostate without any complications. Now patient has no difficulty passing urine and he has no recent attack of urinary tract infection. Knowledge of the differential diagnosis of metabolic defects in men with urinary bladder stones would hopefully provide clinicians with the proper diagnostic tools to more specifically treat such patients with improved success in preventing reformation of urinary tract stones after surgery.
authors.affiliation: Nephrology and Dialysis Center, Department of Medicine, Renal Division, Coney Island Hospital, Brooklyn, NY, USA. goodkidneys@yahoo.com
authors.forename: Adel S
authors.initials: AS
authors.lastname: El-Hennawy
authors.forename: Aarathi
authors.initials: A
authors.lastname: Nagaraja
authors.forename: Aza K
authors.initials: AK
authors.lastname: Mahmood
mesh_terms: D015415:Biomarkers / Q000652:urine; D002951:Citrates / Q000652:urine; D003937:Diagnosis, Differential; D004637:Emergency Services, Psychiatric; D006801:Humans; D006959:Hyperoxaluria / Q000209:etiology; D008297:Male; D008875:Middle Aged; D001744:Urinary Bladder Calculi / Q000150:complications / Q000175:diagnosis* / Q000523:psychology / Q000652:urine; D014555:Urination Disorders / Q000209:etiology* / Q000523:psychology
chemical_list: D015415:Biomarkers; D002951:Citrates