Colossaprostatolithiasis: A case report on a 48-year old male with a giant prostatic calculus

@#While prostatic calculi are said to be overwhelmingly common, it is, however, rare to find patientswith exceptionally large calculi that would cause urinary tract obstruction. Indeed, prostatic calculigenerally remain asymptomatic in almost all men, because of its non-obstructive nature. Presentedhere is the case of a 48-year-old male with one giant prostatic calculus that replaced almost the entiregland. He underwent endoscopic and open surgical management for the stones.

Relations between Prostatic Calculi and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

PURPOSE: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. RESULTS: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. CONCLUSIONS: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients.

A Crystallographic Analysis of Prostatic Calculi according to the Location on Transrectal Prostatic Ultrasonography / 대한비뇨기과학회지

PURPOSE: We studied the crystallographic component of the prostatic calculi according to the location on the transrectal prostatic ultrasonography to know the mechanism of the formation of the calculus. MATERIALS AND METHODS: From August, 1995 until May, 1997, 33 prostatic calculi from 24 patients(mean age 59 years, mean size 3.1mm) operated on for prostatism were analyzed by polarization microscopy(ZeissR), X-ray diffraction(PW-1720R, Philips) and infrared spectrophotometer(FTIR-205R, Nicolet). Location of calculi was divided two groups under guide of transrectal prostatic ultrasonography; periurethral and periadenoma type. The periurethral type showed hyperechoic density around the prostatic urethra and the periadenoma type showed hyperechoic density between adenoma and false prostatic capsule(peripheral zone). RESULTS: 22 calculi were the periurethral type and 11 were periadenoma type. Thirty stones from 20 periurethral type and 10 periadenoma type consisted two or three of the following calcium phospate, calcium oxalate and tricalcium phospate. These are mixed by the endogenous origin formed from the prostatic fluid and the exogenous origin formed at least in part from urine. Three stones (2 calcium oxalate, 1 uric acid) contained only one compound which participitate from urine. All of 11 calculi of the pericapsular type had an oxalate component. CONCLUSIONS: The calculi around the periadenoma region may be formed from not only endogenous component(calcium apatite stone) but also exogenous component(calcium oxalate) or intraductal precipitation of oxalate component which has never found in the prostatic fluid. These results may suggest the necessity of reevaluation about oxalate component within the prostatic fluid.

Evaluation of distribution and size of prostatic calculi in prostatism / 대한비뇨기과학회지

Prostatic calculosis is a physiological feature of the aging process, but it plays an important role in prostatic diseases. Recently we have evaluated the size and location of prostatic calculi in 314 patients with prostatic disease during the period from Aug. 1991 to Feb. 1992 using transrectal ultrasonogram. Prostatic calculi over 3 mm in diameter (with strone echo and posterior acoustic shadow) were observed 12% (3/26) in normal control group, 26% (47/170) in BPH and 20% (17/85) in chronic prostatitis. The incidence or size of prostatic calculi were increased with age. We classifed the calculi "central", when calculus located around the verumontanum or prostatic urethra and "peripheral", when calculus located peripherally. 76% of calculi with prostatitis were located centrally but 59% of calculi with BPH were located peripherally. 69% of calculi with symptom group (patients who complain of voiding dysfunction in 60 years or elder age group without BPH or other urologic diseases) were located centally. Prostatic calculi were also observed in four patients with hematospermia (4/6) and in five patients with-ejaculatory duct cyst (5/6). These results indicate that all prostatic calculi were not asymptomatic and transrectal ultrasonogram should be done to evaluate prostatism. The treatment modality can be chosen and the prognosis estimated by knowing the location and size of prostatic calculi.

The Effects of Concomitant Prostatic Calculi to the Therapeutic Results in Patients with Chronic Bacterial Prostatitis / 대한비뇨기과학회지

Uninfected prostatic calculi cause no symptoms, however, when infected, it serves as a source of resistance against antibiotic therapy. We have performed transabdominal and transrectal prostatic ultrasonography in 64 cases of chronic bacterial prostatitis, and these patients were divided into two groups ; calculi group(42 cases) and non-calculi group(22 cases). All patients of non-calculi group and 37 cases of calculi group were treated with oral antibiotics, and 5 cases of calculi group who had concomitant benign prostatic hyperplasia were treated with transurethral resection. The cure rate of antibiotic therapy in non-calculi group(63. %) was statistically higher than that in calculi group(3S.7%) (p=0.005). Five out of 17 cases in calculi group(42 cases) which had concomitant benign prostatic hyperplasia got transurethral resection and 4 of 5 cases became free from prostatitis after transurethral resection of prostate. Judging from the above results, the prostatic calculi can be easily detected by prostatic ultrasonography in patient with chronic bacterial prostatitis. By knowing the presence of prostatic calculi, the treatment modality can be chosen and the prognosis estimated. Furthermore, transurethral resection of prostate may be useful in the treatment of chronic bacterial prostatitis in old aged patients with benign prostatic hyperplasia.

The Effects of Concomitant Prostatic Calculi to the Therapeutic Results in Patients with Chronic Bacterial Prostatitis / 대한비뇨기과학회지

Uninfected prostatic calculi cause no symptoms, however, when infected, it serves as a source of resistance against antibiotic therapy. We have performed transabdominal and transrectal prostatic ultrasonography in 64 cases of chronic bacterial prostatitis, and these patients were divided into two groups ; calculi group(42 cases) and non-calculi group(22 cases). All patients of non-calculi group and 37 cases of calculi group were treated with oral antibiotics, and 5 cases of calculi group who had concomitant benign prostatic hyperplasia were treated with transurethral resection. The cure rate of antibiotic therapy in non-calculi group(63. %) was statistically higher than that in calculi group(3S.7%) (p=0.005). Five out of 17 cases in calculi group(42 cases) which had concomitant benign prostatic hyperplasia got transurethral resection and 4 of 5 cases became free from prostatitis after transurethral resection of prostate. Judging from the above results, the prostatic calculi can be easily detected by prostatic ultrasonography in patient with chronic bacterial prostatitis. By knowing the presence of prostatic calculi, the treatment modality can be chosen and the prognosis estimated. Furthermore, transurethral resection of prostate may be useful in the treatment of chronic bacterial prostatitis in old aged patients with benign prostatic hyperplasia.