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A 5-year-old boy with a history of recurrent urinary tract infection presented to the emergency department with a history of increasing difficulty passing urine, which required him to strain vigorously. His mother explained that when straining, he would also complain of pain at the tip of his penis, which he found particularly distressing. Twice after passing urine, she had noticed an anal mass, thought to be consistent with a rectal prolapse. On both occasions, this had resolved spontaneously.
An abdominal radiograph (figure 1) showed a 4×3 cm bladder stone with a concentric ring appearance. Urine dipstick was positive for nitrites and leucocytes and subsequently grew Proteus sp., a risk factor for bladder stone formation.1
Bladder stones are rare in children and most will have more than one risk factor.1 In this case, urinary catheterisation during a paediatric intensive care admission 2 years previously for a respiratory illness may have provided a nidus for stone formation.
A further episode of rectal prolapse occurred while the child was in the emergency department and this was easily reduced. He was admitted and later transferred for surgical stone removal. The association between large bladder stones and rectal prolapse has been previously reported,2 and straining to pass urine should prompt consideration of bladder imaging.
Competing interests None.
Patient consent Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.