Calcium tartrate tetrahydrate bladder stone.

Bladder stones account for only 5% of urinary tract stones, and calcium tartrate tetrahydrate (CTT) stones are exceedingly rare. We present the case of a man in his early 60s with untreated diabetes, hypertension and chronic pesticide exposure, who developed a 24.1 mm × 35.6 mm bladder stone. Stone analysis revealed 100% CTT composition, a finding reported predominantly in animal models and only rarely in humans. The patient's history of excessive consumption of energy drinks and supplements containing L-carnitine L-tartrate, combined with occupational pesticide exposure and neurogenic bladder, likely contributed to stone formation. This case highlights potential environmental and metabolic risk factors for CTT stones, including dietary tartrate, supplement use and chemical exposure. Recognition of such associations is crucial, as these stones pose diagnostic and therapeutic challenges. Further investigation is needed to clarify how dietary tartrate and occupational exposures may contribute to rare bladder stone pathogenesis.