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  IN THIS Article
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgemnts
 ::  References

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Year : 1983  |  Volume : 29  |  Issue : 1  |  Page : 49-50

Giant prostatic urethral calculus. (A case report).







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


How to cite this URL:
Deodhar S D, Khope S S. Giant prostatic urethral calculus. (A case report). J Postgrad Med [serial online] 1983 [cited 2019 Nov 14];29:49-50. Available from: http://www.jpgmonline.com/text.asp?1983/29/1/49/5553




  ::   Introduction Top

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.

  ::   Case report Top

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.

  ::   Discussion Top

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.

  ::   Acknowledgemnts Top

Our thanks are due to Dr. C. K. Deshpande, Dean, K.E.M. Hospital, for permitting us to publish the case report.

  ::   References Top

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.  Back to cited text no. 1    
2.Fletcher, H. C.: "Essentials of Urology." 4th Edition, Williams and Wilkins Company, Baltimore, 1961, pp. 449.  Back to cited text no. 2    
3.Lowsley, O. S. and Kirwin, J. J.: "Clinical Urology" 3rd Edition. Vol. 1, Williams and Wilkins Company, Baltimore, 1956, pp. 317-319.  Back to cited text no. 3    

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow