Giant Bladder Calculus Presenting as A Rare Cause of Renal Impairment in A Young Adult with Substance Use Disorder.

BACKGROUND: Giant vesical calculi, defined as stones larger than 40 mm and weighing over 100 grams, are uncommon in young patients. In developed countries, only a limited number of case reports have been published, and no previous cases have been reported in patients with substance use disorder. CASE REPORT: The rare case of a young male presenting with a giant bladder calculus causing obstructive nephropathy and renal impairment is reported. The patient had a history of substance use disorder, mainly opioids, and suffered from chronic urinary retention. Clinical and biochemical recovery was achieved after open cystolithotomy and antibiotic treatment for concomitant urinary infection. CONCLUSION: Vesical lithiasis can occur in young individuals with chronic substance abuse due to urinary stasis. Opioids have been implicated in the development of chronic urinary retention. In severe cases, the progressive formation of giant stones can be complicated by chronic renal impairment, obstructive hydronephrosis and urinary tract infections. Surgical management with open cystolithotomy remains the gold standard treatment when not contraindicated. LEARNING POINTS: Despite their rarity, giant vesical calculi should be an important diagnostic consideration in young individuals presenting with renal impairmentHidden predisposing factors such as chronic substance abuse may result in chronic urinary retention and stone formation.Delayed diagnosis and treatment of giant stones can result in chronic kidney injury with bilateral hydronephrosis, necessitating invasive therapeutic interventions.