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Abstract：
BACKGROUND: Giant stones of the urinary bladder (GSBs) are rare and usually presented as case reports. We aimed to assess the clinical and surgical characteristics of GSBs and identify their predictors.
METHODS: A retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients\' demographics, clinical presentations, and surgical peculiarities were studied.
RESULTS: Older age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa.
CONCLUSIONS: Solitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.
METHODS: A retrospective study of 74 patients with GSBs who presented between July, 2005 and June, 2020 was performed. Patients\' demographics, clinical presentations, and surgical peculiarities were studied.
RESULTS: Older age and male gender were risk factors for the occurrence of GSBs. The irritative lower urinary tract symptoms (iLUTS) were the main presenting symptoms (97.3%). Most patients were treated with cystolithotomy (90.1%). Univariate analyses showed that solitary (p < 0.001) and rough surface (P = 0.009) stones were significant factors for occurrence of iLUTS as the presenting symptoms. Also, the severity of symptoms (p = 0.021), rough surface (p = 0.010) and size (p < 0.001) of stones, and farmer occupation (p = 0.009) were significantly associated with adherence of the stone to the bladder mucosa at surgery. In multivariate analysis, the rough surface (p = 0.014) and solitary (p = 0.006) stones, and concomitant ureteral stones (p = 0.020) were independently associated with iLUTS as the main presentation. However, the stone size and severity of iLUTS were the independently associated factors for adherence of GSBs to the bladder mucosa.
CONCLUSIONS: Solitary GSB, rough surface and the association with ureteral stones are independent risk factors for the occurrence of long-standing iLUTS. The stone size and severity of iLUTS were the independent predictors of adherence of GSBs to the bladder mucosa. Cystolithotomy is the main treatment, but it may be more difficult when there is bladder mucosa adherence.
摘要：
背景：膀胱巨大结石（GSB）是罕见的，通常作为病例报告。我们旨在评估GSB的临床和手术特征，并确定其预测因素。
方法：一项对74例GSB患者的回顾性研究，这些患者在7月之间2005年6月,2020年执行。患者人口统计学，临床表现,和手术的特殊性进行了研究。
结果：年龄和男性是GSBs发生的危险因素。下尿路刺激性症状（iLUTS）是主要症状（97.3％）。大多数患者接受膀胱切开取石术(90.1%)。单变量分析表明，孤立（p<0.001）和粗糙表面（P=0.009）的结石是出现iLUTS症状的重要因素。此外，症状的严重程度（p=0.021），粗糙表面（p=0.010）和大小（p<0.001）的石头，和农民职业（p=0.009）与手术中结石对膀胱粘膜的粘附显着相关。在多变量分析中，粗糙的表面（p=0.014）和孤立的（p=0.006）石头，合并输尿管结石（p=0.020）与iLUTS独立相关。然而,结石大小和iLUTS的严重程度是GSBs与膀胱粘膜粘附的独立相关因素.
结论：单独的GSB，表面粗糙和与输尿管结石的关联是长期iLUTS发生的独立危险因素。结石大小和iLUTS的严重程度是GSB与膀胱粘膜粘附的独立预测因子。膀胱切开取石术是主要的治疗方法，但是当膀胱粘膜粘连时可能会更困难。
方法：一项对74例GSB患者的回顾性研究，这些患者在7月之间2005年6月,2020年执行。患者人口统计学，临床表现,和手术的特殊性进行了研究。
结果：年龄和男性是GSBs发生的危险因素。下尿路刺激性症状（iLUTS）是主要症状（97.3％）。大多数患者接受膀胱切开取石术(90.1%)。单变量分析表明，孤立（p<0.001）和粗糙表面（P=0.009）的结石是出现iLUTS症状的重要因素。此外，症状的严重程度（p=0.021），粗糙表面（p=0.010）和大小（p<0.001）的石头，和农民职业（p=0.009）与手术中结石对膀胱粘膜的粘附显着相关。在多变量分析中，粗糙的表面（p=0.014）和孤立的（p=0.006）石头，合并输尿管结石（p=0.020）与iLUTS独立相关。然而,结石大小和iLUTS的严重程度是GSBs与膀胱粘膜粘附的独立相关因素.
结论：单独的GSB，表面粗糙和与输尿管结石的关联是长期iLUTS发生的独立危险因素。结石大小和iLUTS的严重程度是GSB与膀胱粘膜粘附的独立预测因子。膀胱切开取石术是主要的治疗方法，但是当膀胱粘膜粘连时可能会更困难。
