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We present a case of a man in his 40s with a prior history of a gunshot wound to the abdomen who presented with leakage from a previously healed suprapubic tube tract and was found to have a giant bladder stone with a resulting renal injury. He subsequently underwent a combined open cystolithotomy and vesicocutaneous fistulotomy during his hospitalisation, which helped to improve his renal function. In addition to there being few reported cases of bladder stones &gt;10\u2009cm, this represents the first report in the literature of an associated decompressive \u2018pop-off\u2019 mechanism through a fistulised tract.<\/jats:p>","DOI":"10.1136\/bcr-2023-256204","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T11:55:20Z","timestamp":1714478120000},"page":"e256204","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Vesicocutaneous fistula at site of closed suprapubic tube tract as the first presenting sign of giant bladder stone"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0399-5512","authenticated-orcid":false,"given":"Brian","family":"Thomas","sequence":"first","affiliation":[{"name":"Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA"},{"name":"Urology, Bryn Mawr Hospital \/ Main Line Health System, Bryn Mawr, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamir","family":"Sholklapper","sequence":"additional","affiliation":[{"name":"Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Nourian","sequence":"additional","affiliation":[{"name":"Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serge","family":"Ginzburg","sequence":"additional","affiliation":[{"name":"Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"2025082703445028000_17.4.e256204.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0094-0143(05)70262-7"},{"key":"2025082703445028000_17.4.e256204.2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/bju.13409","article-title":"Do stones still kill? an analysis of death from stone disease 1999\u20132013 in England and Wales","volume":"118","author":"Kum","year":"2016","journal-title":"BJU Int"},{"key":"2025082703445028000_17.4.e256204.3","first-page":"101","article-title":"Epidemiology of Urolithiasis: an update","volume":"5","author":"Trinchieri","year":"2008","journal-title":"Clin Cases Miner Bone Metab"},{"key":"2025082703445028000_17.4.e256204.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2005.12.038"},{"key":"2025082703445028000_17.4.e256204.5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ijscr.2020.09.028","article-title":"Bladder stones associated with Vesicovaginal Fistula: A case report","volume":"75","author":"Kholis","year":"2020","journal-title":"Int J Surg Case Rep"},{"key":"2025082703445028000_17.4.e256204.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-234339","article-title":"Obstructive Uropathy from a giant urinary bladder stone: a rare Urological emergency","volume":"14","author":"Mukherjee","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082703445028000_17.4.e256204.7","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000004323","article-title":"Giant bladder stone in a male patient: A case report","volume":"95","author":"Ma","year":"2016","journal-title":"Medicine"},{"key":"2025082703445028000_17.4.e256204.8","doi-asserted-by":"crossref","unstructured":"Agrawal R , Taha K , Poudyal A , et al . 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