{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T18:37:28Z","timestamp":1788633448118,"version":"build-2803163510"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Urol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neobladder urolithiasis represents a significant long-term complication following radical cystectomy with orthotopic reconstruction, with incidence ranging from 3-9% for ileal neobladders to as high as 43% for Kock pouch configurations. Giant stones are rare and usually result from prolonged gaps in surveillance combined with inadequate preventive measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient presentation<\/jats:title>\n                    <jats:p>This is a case of a 78-year-old male presenting with progressive lower urinary tract symptoms after 18 years without urological follow-up following radical cystoprostatectomy and ileal neobladder reconstruction for muscle-invasive bladder cancer (pT2N0M0) performed in 2006. He had relocated geographically one year post-surgery and stopped all urological care, never performing self-catheterization or bladder irrigation as instructed. Computed tomography revealed two massive neobladder stones measuring 10\u00d78\u00d76 cm and 9\u00d77\u00d78 cm with 1,300 Hounsfield Units density. Open cystolithotomy successfully removed both calculi with a combined weight of 950 grams in 90 minutes with minimal blood loss of 100 mL and no complications. Stone analysis confirmed a pure struvite-carbonate apatite composition secondary to chronic Proteus mirabilis infection. The patient was discharged on postoperative day 3. Follow-up at 1, 3, 6, and 12 months demonstrated complete symptom resolution, stone-free status on imaging, and stable renal function. However, the patient was subsequently lost to follow-up again after 12 months despite multiple attempts at contact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u20131000 mL normal saline, adequate hydration (\u22652.5 L daily), aggressive infection control with surveillance cultures every 3\u20136 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\u2019s stone-free status during the 12-month compliant period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fruro.2026.1757555","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:14:35Z","timestamp":1775103275000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Dual giant neobladder stones weighing 950 grams following 18-year loss to follow-up: surgical management and prevention strategies"],"prefix":"10.3389","volume":"6","author":[{"given":"Youssef","family":"Maachi","sequence":"first","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Boustani","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine Salim","family":"Lalaoui","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Slaoui","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Karmouni","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdellatif","family":"Koutani","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Elkhader","sequence":"additional","affiliation":[{"name":"Department of Urology, Universit\u00e9 Mohammed V de Rabat","place":["Rabat, Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.3.666","article-title":"Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients","volume":"19","author":"Stein","year":"2001","journal-title":"J Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-020-02544-z","article-title":"Health-related quality of life overview after different curative treatment options in muscle-invasive bladder cancer: an umbrella review","volume":"29","author":"Rammant","year":"2020","journal-title":"Qual Life Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s003450050163","article-title":"Incidence of urolithiasis in cystectomy patients after intestinal conduit or continent urinary diversion","volume":"17","author":"Turk","year":"1999","journal-title":"World J Urol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)66541-8","article-title":"Urinary calculi as a late complication of the Indiana continent urinary diversion: comparison with the Kock pouch procedure","volume":"155","author":"Terai","year":"1996","journal-title":"J Urol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2011.02.006","article-title":"25 years of experience with 1,000 neobladders: long-term complications","volume":"185","author":"Hautmann","year":"2011","journal-title":"J Urol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/00042307-200207000-00007","article-title":"Stones in urinary diversions: update on medical and surgical issues","volume":"12","author":"Beiko","year":"2002","journal-title":"Curr Opin Urol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyi112","article-title":"Long-term functional outcome and late complications of Studer\u2019s ileal neobladder","volume":"35","author":"Tanaka","year":"2005","journal-title":"Jpn J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/iju5.70026","article-title":"A case of giant neobladder stone of 5 kg","volume":"8","author":"Hiruma","year":"2025","journal-title":"IJU Case Rep"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2024.102090","article-title":"Early and late post-procedural complications in different orthotopic neobladder surgical approaches: a systematic review","volume":"56","author":"Mirto","year":"2024","journal-title":"Surg Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14040392","article-title":"Advances in urinary diversion: from cutaneous ureterostomy to orthotopic neobladder reconstruction\u2014a comprehensive review","volume":"14","author":"Barone","year":"2024","journal-title":"J Pers Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2023.1105146","article-title":"A giant neobladder stone with insignificant symptoms: a case report and literature review","volume":"10","author":"Gu","year":"2023","journal-title":"Front Surg"},{"key":"B12","article-title":"Giant Bladder Stone Nine Years After Neobladder Construction: A Case Report","volume-title":"Hinyokika Kiyo","author":"Hatanaka","year":"2008"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12276","article-title":"Giant Neobladder Stone","volume":"84","author":"Tiu","year":"2014","journal-title":"Anz J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1056\/NEJMicm1611578","article-title":"Neobladder Stone","volume":"377","author":"Nguyen","year":"2017","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s12894-022-01040-5","article-title":"Delayed Ileal Neobladder Fistula Caused by Bladder Stones: A Case Report","volume":"22","author":"Lu","year":"2022","journal-title":"BMC Urol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2009.09006.x","article-title":"Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients","volume":"106","author":"Miyake","year":"2010","journal-title":"BJU Int"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.eucr.2023.102474","article-title":"A successful open neocystolithotomy in studer neobladder with Mitrofanoff for multiple large neobladder stones: a case report and review of the literature","volume":"50","author":"Moazin","year":"2023","journal-title":"Urol Case Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.4103\/0974-7796.65114","article-title":"Large orthotopic reservoir stone burden: role of open surgery","volume":"2","author":"Madbouly","year":"2010","journal-title":"Urol Ann"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-5347(17)36657-0","article-title":"Lithogenic properties of enterocystoplasty","volume":"148","author":"Blyth","year":"1992","journal-title":"J Urol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1080\/21681805.2017.1290677","article-title":"Management of neobladder complications: endoscopy comes first","volume":"51","author":"Moeen","year":"2017","journal-title":"Scand J Urol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2014.09.008","article-title":"Risk assessment of stone formation in stapled orthotopic ileal neobladder","volume":"193","author":"Ferriero","year":"2015","journal-title":"J Urol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410x.2003.04664.x","article-title":"Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol","volume":"93","author":"Hensle","year":"2004","journal-title":"BJU Int"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/03915603241258697","article-title":"The role of alternative medicine and complementary therapies in urological diseases: new horizons","volume":"91","author":"Bizzarri","year":"2024","journal-title":"Urologia"}],"container-title":["Frontiers in Urology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fruro.2026.1757555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:14:59Z","timestamp":1775103299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fruro.2026.1757555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":23,"alternative-id":["10.3389\/fruro.2026.1757555"],"URL":"https:\/\/doi.org\/10.3389\/fruro.2026.1757555","relation":{},"ISSN":["2673-9828"],"issn-type":[{"value":"2673-9828","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"article-number":"1757555"}}