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A healthy 26-year-old driver had routine laboratory tests performed to renew his driver's license. Hematuria (3+) was incidentally noted. He reported having had no urinary tract symptoms. Abdominal radiography of the kidneys, ureters, and bladder showed large bladder stones (Panel A, with a Foley catheter tube visible). During cystotomy, two large stones, measuring 8 cm and 3 cm in diameter, were removed (Panel B). These stones were found to contain both calcium phosphate and uric acid and were infected with Proteus mirabilis. No structural bladder-outlet obstruction or other anatomical abnormalities were identified. The patient recovered quickly from the surgery and was discharged 2 days after the procedure. The infection was treated with 500 mg of ciprofloxacin twice daily. Whereas a small stone (only millimeters in size) often causes significant pain as it travels through a narrow ureter, bladder calculi may become large and yet not cause symptoms.
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