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| Year : 1983 | Volume
: 29
| Issue : 1 | Page : 49-50 |
Giant prostatic urethral calculus. (A case report).
Deodhar SD, Khope SS
How to cite this article:
Deodhar S D, Khope S S. Giant prostatic urethral calculus. (A case report). J Postgrad Med 1983;29:49-50 |
Prostatic urethral calculi are not uncommon in a busy surgical practice, but giant calculi in the prostatic urethra are rare.[2] We had recently, under our care, a case of this type. The rarity of this condition prompted us to present this case.
P.B., a 70 year old male, was admitted to the K.E.M. Hospital, Bombay, on 21-10-1981 with a history of dysuria, and progressive diminishing urinary stream accompanied by dribbling of 6 months' duration. Six years earlier, he had undergone a suprapubic cystolithotomy for a vesical calculus at another hospital.
On examination, a 4 inches long raid-line suprapubic scar was seen; the urinary bladder was partially distended. Rectal examination revealed a hard, smooth mass, 5 cm x 3 cm, in place of the normal prostate. The external urethra and the genitalia were normal. Kidneys were not enlarged. B.P. was 160/100 mm of Hg.
Urine examination showed crystals of triple phosphate; a culture revealed the presence of Klebsiella (A count of more than 106/cmm) which was sensitive only to gentamicin and mandelamine. Other investigations were within normal limits, except a mild degree of anemia. Plain X-ray showed a large homogenous, smooth, oval, radio-opaque shadow behind and below the pubic symphysis [Fig. 1]. Intravenous pyelography showed normal renal function. There were no other calculi in the urinary system. A cystourethroscopy was attempted under local anesthesia; the distal urethra was normal, the stone was firmly wedged and could not be pushed back into the bladder.
At operation on 26-10-1981, the bladder was re-opened through the previous incision and the stone was removed, though with a little difficulty, because of Adhesions to the surrounding urethra. The post-operative course was uneventful.
The external characters of the stone were as seen in [Fig. 2]. The stone weighed 45 gm. A chemical analysis of the stone revealed the presence of calcium and ammonium phosphates.
Urethral stones are classified as (a) primary or autochthonous and (b) secondary or migrating depending upon their site of origin.[1], [3]
Secondary stones are much more common and are the ones which have migrated from higher up in the urinary tract.[1], [2], [3]
Primary stones are phosphatic in composition, have no nucleus and are of uniform structure. They are formed in the urethra either behind some obstruction or within a poorly drained communicating cavity, stagnation plus infection being the predisposing factors.[1], [3] Urethral calculi are preponderantly found in the prostatic urethra just proximal to the narrow membranous portion.
Urethral calculi are usually small, but numerous cases of giant stones have been reported .[3]
Urethral calculi may be completely asymptomatic or may be accompanied by one of the following symptoms: perineal or penile pain, frequency, urgency, diminished urinary stream, dribbling and hematuria or urethral discharge. The diagnosis is based on clinical history and relevant investigations.[1], [2], [3]
Large stones obviously require surgical removal. The exact reason for the presence of such a large stone in our case is not clear, as the distal urethra on cystourethroscopy was normal and free from obstruction.
Our thanks are due to Dr. C. K. Deshpande, Dean, K.E.M. Hospital, for permitting us to publish the case report.
| 1. | Drach, G. W.: In, "Campbell's Urology", Vol. 1, Editors: Harrison, J. H., Gittes. R. F., Perlmutter, A. D., Stamey, T. A. and Walsh, P. C., W.B. Saunders Company, Philadelphia, London and Toronto, 1978 pp. 859-860.  |
| 2. | Fletcher, H. C.: "Essentials of Urology." 4th Edition, Williams and Wilkins Company, Baltimore, 1961, pp. 449. |
| 3. | Lowsley, O. S. and Kirwin, J. J.: "Clinical Urology" 3rd Edition. Vol. 1, Williams and Wilkins Company, Baltimore, 1956, pp. 317-319. |
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