A Giant Dumbbell Shaped Vesico-Prostatic Urethral Calculus: A Case Report and Review of Literature

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Abstract

Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.

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Most cited references 48

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Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis.

Edward D. Lowe, Lindsay Shuttleworth, Emma Kirby … (1982)

That urine might reflux into the prostatic ducts during micturition has never before been proved. Using a suspension of carbon particles it has been demonstrated that this can occur. It is suggested that this may be important both as a route of infection in bacterial prostatitis and as a cause of the inflammatory process in abacterial prostatitis.

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Analysis of the inflammatory network in benign prostate hyperplasia and prostate cancer.

Wolfgang König, Theodor Senge, Ernst Allhoff … (2004)

The complexity of acute and chronic inflammatory processes may either lead to benign prostate hyperplasia (BPH) and/or prostate cancer. Obviously, various tissue cells are activated by chemokines via different chemotaxin receptors which then trigger subsequent processes in angiogenesis, cellular growth, and extravasation as well as neoplasia. Using the surgically obtained tissue of patients (n = 36) with BPH or prostate carcinoma (PCA), we studied among others the expression of chemokines (Rantes, IL-8), chemotaxin receptors (CXCR-3 and -4, CCR-3, CCR-5), of matrixmetalloproteinases (MMP-2 and 9), of Toll-like (TL) receptors 1, 2, 3, 4, 5, 7, and 9 and of the inducible cyclooxygenase-2 (cox-2) by RT-PCR. Further support for the different properties of tissue from PCA was obtained using two different PCA cell lines (PC3 = androgen resistant cell) or LNCAP cells (androgen sensitive) with emphasis on IL-8, Il-6, and PGE(2) release. Cell lines were stimulated with either the tumor necrosis factor-alpha (TNF-alpha) and lipopolysacharide (LPS) over time. In addition to cytokine release, the quantification of mRNA by lightcycler for cox-2, IL-6, and IL-8 was performed on these cell lines. Remarkable differences in expression were obtained by RT-PCR when BPH tissue versus PCA was analyzed. Expression of CXCR-1 after incubation with LPS and TNF-alpha showed time-dependent differences for androgen-sensitive LNCAP as compared to androgen-resistant PC-3 cells. TNF-alpha incubation leads to a time-dependent induction of cox-2 expression unlike to activation with LPS. Differences with regard to cox-2, IL-6, and IL-8 expression were seen by quantitative lightcycler analysis. Significant differences were also observed when TL receptors 4, 5, 7, and 9 were analyzed which were significantly expressed in BPH- as compared to PCA-tissue. Our data clearly demonstrate that various inflammatory and cell biological cascades are involved which either lead to BPH or can be linked to the development of PCA. The exact cell biological mechanisms may provide novel therapeutic options in the treatment of both diseases. Copyright 2003 Wiley-Liss, Inc.

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Prostatic calculi: a review.

R. Gardner, Michael B. Bennett, R Klimas (1984)

Prostatic calculi are rare in children, infrequent below age 40, and common in males over 50. They may be solitary but usually occur in clusters and are associated with some other disease process (nodular hyperplasia, prostatic carcinoma, metabolic abnormalities). They are most often asymptomatic; however, symptoms that may be attributable to prostatic calculi include reduction of the urinary stream, prostatism, and intense lower back and leg pain. Treatment may be accomplished by transurethral resection, but prostatectomy is the best means to insure complete removal. Prostatic calculi may form by two related mechanisms with obstruction and stasis of prostatic fluid as central entities in both. These mechanisms are calcification of corpora amylacea and simple precipitation of prostatic secretion. They may arise spontaneously, initiating an inflammatory reaction that contributes to their growth, or they may arise as the consequence of another pathologic situation producing acinar obstruction. It appears that infection probably occurs secondary to stone formation.