Journal of Postgraduate Medicine
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ARTICLE
 
 
Year : 1977  |  Volume : 23  |  Issue : 3  |  Page : 135-136  

Prostatic calculi- (a case report)

VV Dewoolkar, RP Usgaonkar, BB Pardiwala, DN Galwankar, Sulabha V Punekar, DS Pardanani 
 Department of Surgery, Seth G. S. Medical College and K. E. M. Hospital, Parel, Bombay-400 012, India

Correspondence Address:
V V Dewoolkar
Department of Surgery, Seth G. S. Medical College and K. E. M. Hospital, Parel, Bombay-400 012
India

Abstract

An interesting case of unusually large, multiple, faceted prostatic calculi is presented. The probable aetiopathology is discussed.



How to cite this article:
Dewoolkar V V, Usgaonkar R P, Pardiwala B B, Galwankar D N, Punekar SV, Pardanani D S. Prostatic calculi- (a case report).J Postgrad Med 1977;23:135-136


How to cite this URL:
Dewoolkar V V, Usgaonkar R P, Pardiwala B B, Galwankar D N, Punekar SV, Pardanani D S. Prostatic calculi- (a case report). J Postgrad Med [serial online] 1977 [cited 2022 Aug 20 ];23:135-136
Available from: https://www.jpgmonline.com/text.asp?1977/23/3/135/42767


Full Text

 Introduction



Multiple prostatic calculi occupying the prostatic fossa are rare.

Senile prostate some times shows calci­fication of corpora amylaceae. [1] Calculous prostatitis may also occur in young pati­ents following local or systemic patho­logy. e.g. stricture urethra, recurrent urinary tract infection and hypercalci­uria. The third group includes calculi which are formed elsewhere in the urinary tract but lodge in the prostatic urethra. They are called `Pseudocalculi'. [1]

We are presenting this case of unusual­ly large calculi which presumably formed as a result of infection.

 Case report



A 60 year old male patient presented with complaints of difficulty in passing urine, fre­quency of micturition, (D/N:8/3) and urge in­ continence. All these symptoms gradually in­creased in four months. There was no history of urinary retention, passing gravel in the urine or pyuria. The patient was not diabetic or hypertensive. The patient had not undergone any instrumentation or surgery on the urinary tract. Ile did not give history of venereal disease.

On clinical examination, the patient was in fair general health. Hernial orifices were normal and there was no palpable bladder. External genitalia were normal.

On rectal examination the prostatic region was felt stony hard with grating sensation. An X-ray of the abdomen and pelvis showed normal renal outlines. No radio-opaque shadows were seen in the region of the kidneys, ureters and the blad­der. In the region of the prostate, large radio­-opaque shadows were seen See [Figure 1] on page 136a. There was one large oval stone near the apex of the prostate and multiple faceted stones were seen in the prostatic cavity. A micturating cystourethrogram showed normal sized bladder and normal distal urethra. The prostatic urethra was the site of multiple calculi. See [Figure 2] on page 136a.

Laboratory investigations: Haemoglobin was 14.0 Grams%. Urine showed trace of albumin, with few R.B.Cs., epithelial cells and 50-60 W.B.Cs/H.P.F. Urine culture showed Klebsiella and Pseudomonas. B.U.N. was 16 mg.% and blood sugar was 60 mg % Alkaline phosphatase was 9.2 K.A.U. Acid phosphatase was 1.4 K.A. units. Serum calcium levels were within normal limits.

Surgical removal of the calculi was carried out. The prostatic urethra was approached re­tropubically. On incising the prostatic capsule anteriorly, a large cavity was seen extending from the bladder neck to the membraneous ure­thra. An oval calculus of the size 3.5 cms x 2.5 cms x 2 cms. was seen occupying the distal part of the cavity. The cavity itself contained nine more faceted calculi of varying sizes from 0.5 cms. X 1.0 cms. to 2.7 cms X 1.6 cms See [Figure 3] on page 136a. The prostatic tissue was stretched over the calculi. All the calculi were removed and the prostatic capsule was closed after proper haemostasis. Chemical analysis of the calculi showed calcium phosphate only.

The postoperative period was uneventful ex­cept that the patient developed some degree of incontinence and dribbling. He received urinary antiseptics and physiotherapy with faradic stimulation of the external sphincter. Fair degree of continence was restored.

 Discussion



Generally large multiple prostatic cal­culi are associated with distal stricture of the urethra and cuncurrent urinary tract infection. [1],[2] In the present case there was no associated pathology or demonstrable stricture of the urethra. Repeated bacte­riological examination of the urine how­ever showed the presence of infection. From the faceted appearance and the large size of the calculi it is obvious that these calculi had primarily formed and grown in size in the prostatic urethra.

In the absence of obvious local or syste­mic pathology, it was difficult to speculate what initiated the formation of these stones and also what factors led to their growth to such a large size. Multiple pros­tatic calculi without any obvious urethral stricture have been reported by other workers. [1],[3]

We feel that in the present case the process of multiple stone formation was initiated by the partial obstruction caused by the oval stone. This stone had presum­ably formed in the urinary bladder and subsequently lodged in the prostatic urethra.

 Acknowledgement



We are thankful to the Dean, K.E.M. Hospital Parel, Bombay-12 for permitting us to use hospital data and to publish this paper.

References

1Fox, M.: The natural history and signific­ance o`' stone formation in the prostate gland. J. Urol., 89: 716-727, 1963.
2Karanjawalla, D. K.: Personal Communi­cation-1976.
3Robert, K. V. and Stephen, A. K.: Short case report: obstructing prostatic urethral calculi. Brit. J. Urol., 48: 492, 1976.

 
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