Case Report: Dual giant neobladder stones weighing 950 grams following 18-year loss to follow-up: surgical management and prevention strategies

Abstract

This case, representing one of the heaviest dual-stone presentations documented in neobladder patients (950g combined weight), demonstrates that complete surgical excision via open cystolithotomy remains the treatment of choice for giant neobladder calculi. The exceptionally prolonged 18-year surveillance gap enabled progressive bilateral stone development, emphasizing the absolute necessity of lifelong structured follow-up programs for all urinary diversion patients. Comprehensive preventive strategies including daily bladder irrigation with 500-1000 mL normal saline, adequate hydration (≥2.5 L daily), aggressive infection control with surveillance cultures every 3-6 months and suppressive antibiotic prophylaxis when indicated, and regular imaging surveillance are essential to prevent such severe complications. Even after prolonged follow-up loss and massive stone development, curative intervention can achieve excellent outcomes when patients subsequently engage with comprehensive preventive protocols, as demonstrated by this patient's stone-free status during the 12-month compliant period.