Multiple bladder calculi after radical prostatectomy due to bladder neck stenosis in a patient with hypertrophic scar: A case report

Abstract

Introduction and importance

Bladder calculi after radical prostatectomy is rare and usually associated with migrated clips into the bladder forming a nidus. We present a patient with multiple bladder calculi resulting from bladder neck stenosis after radical prostatectomy causing bothersome lower urinary tract symptoms. He had an associated hypertrophic scar.

Case presentation

A 60-year-old man of African ancestry presented with recent onset of irritative urinary symptoms three years after radical prostatectomy. Abdomen pelvic ultrasound and pelvic X-ray revealed a urinary bladder calculus. Examination of the previous radical prostatectomy scar found him to have a hypertrophic scar.

He had urethroscopy with bladder neck incision for bladder neck stenosis and cystolithotomy with resolution of the symptoms.

Clinical discussion

The presentation was that of dysuria and frequency three years after radical prostatectomy. The cause of the symptoms was diagnosed after an abdomen pelvic ultrasound and pelvic X-ray as multiple bladder calculi. This is a rare finding with the few reported cases associated with clips that migrated to the urinary bladder forming a nidus for the calculi. This was of consideration in the case presented, however, the findings at urethroscopy revealed bladder neck stenosis suggesting stasis as possible cause of the bladder calculi. The symptoms resolved after bladder neck incision and cystolithotomy.

Conclusion

In addition to clips forming a nidus for calculi in the urinary bladder after radical prostatectomy, bladder neck stenosis being the cause of urinary bladder calculi should be considered in a patient with hypertrophic scar.

Highlights

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  Bladder calculi after radical prostatectomy is rare and usually associated with migrated clips into the bladder.

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  In patients with hypertrophic scars, there is the potential to form thick fibrosis at the reconstructed bladder neck

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  The resulting urinary stasis may lead to calculi formation in the urinary bladder.

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  Cystolithotomy, following bladder neck incision, preserves the integrity of the sphincter mechanism