116-118 latrogenic stone

OLGU SUNUMU/CASE REPORT
Akad Geriatri 2009; 1: 116-118
Gelifl Tarihi/Received: 17/03/2009 - Kabul Edilifl Tarihi/Accepted: 14/04/2009
Iatrogenic Stone Formation on Absorbable
Suture Following Radical Retropubic
Prostatectomy in an Elderly Patient
Yafll› Bir Hastada
Radikal Retropubik Prostatektomi Ameliyat› Sonras›
Sütür Materyali Üzerinde Tafl Geliflimi
Berkan Reflorlu, Semih Tangal, Mehmet ‹lker Gökçe, Sadettin Küpeli
Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
Ankara Üniversitesi T›p Fakültesi, Üroloji Anabilim Dal›, Ankara, Türkiye
ÖZET
Absorbe olan sütürler üzerinde tafl oluflumu oldukça nadirdir. Bu yaz›da yafll› bir hastada radikal retropubik prostatektomi
ameliyat› sonras› dorsal venöz kompleksi ba¤lamak için kullan›lan sütür materyalinin üzerinde geliflen bir üretral tafl oluflumu
rapor edilmifltir.
Anahtar Kelimeler: Endoskopi, radikal prostatektomi, tafl oluflumu, üretra.
ABSTRACT
Calculi formation on absorbable sutures is a very rare condition. We report a case of urethral stone formation in an elderly patient
after radical retropubic prostatectomy caused by a suture material used to ligate the dorsal vein complex.
Key Words: Endoscopy, radical prostatectomy, stone formation, urethra.
INTRODUCTION
CASE REPORT
Urethral calculi is a rare condition and it usually develops by migration of a bladder calculi. But calculi formation primarily in the urethra may develop due to an
obstructive cause either congenital or acquired. In this case we present a patient having urethral calculi secondary
to a postprostatectomy suture material in a elderly man.
116
The 66 year old patient had undergone radical retropubic prostatectomy in 2004. He neither had urinary incontinence nor signs of infravesical obstruction
during the routine controls in the postoperative period. He admitted to our outpatient clinics with the
complaints of dysuria, frequency, poor urinary stream,
Yaz›flma Adresi/Address for Correspondence
Dr. Berkan Reflorlu
Kardefller Koop. 182. Cadde, 175. Sokak No: 14/8, Ayval›, 06010 Ankara/Türkiye
e-posta: [email protected]
Reflorlu B, Tangal S, Gökçe M‹, Küpeli S.
Yafll› Bir Hastada Radikal Retropubik Prostatektomi Ameliyat›
Sonras› Sütür Materyali Üzerinde Tafl Geliflimi
feeling of residual urine and dribbling. Obstructive
uroflowmetric pattern was detected (Figure 1). Mild
ureterohydronephrosis and a hypoechoic mass just
distal to the bladder neck were detected in the ultrasound scan. The patient is evaluated with urethroscopy
and urethral calculi developing on the basis of suture
material is detected in the posterior urethra. The calculus is taken out with the foreign body forceps (Figure 2A, 2B).
DISCUSSION
Urethral calculi is uncommon; the majority is of
upper tract or bladder origin and migrates into the
urethra (1). They are estimated to represent 0.3% of
all urinary stone diseases (2). Urethral stones are re-
ported to be relatively more frequent in childhood,
particularly in developing countries, because of the
high prevalence of bladder calculi. Most of the present
calculi (86%) were calcium oxalate, with 6% and 2%,
respectively, being struvite and uric acid (3). Some
authors consider that urethral stones are usually radiolucent and that a uroradiographic diagnosis is made
in only 40% of cases (3,4). These stones can be classified as either migrant or native with the former being
responsible for roughly 90% of all stones. Migrant
stones originate in the bladder or upper tracts and generally become impacted in the posterior urethra (5).
Native urethral stones may develop with associated
anatomic abnormalities or postsurgical changes (5). In
UROFLOWMETRY
POST_PROCESSING
2_FRm
min:sec
0:10
0:20
0:30
0:40
0:50
1:00
1:10
1:20
1:30
1:40
Figure 1. Obstructive uroflowmetric pattern.
Figure 2A. The calculus at posterior urethra.
Akad Geriatri 2009; 1: 116-118
Figure 2B. The calculus is taken out with forceps.
117
Reflorlu B, Tangal S, Gökçe M‹, Küpeli S.
Iatrogenic Stone Formation on Absorbable Suture Following
Radical Retropubic Prostatectomy in an Elderly Patient
general, the most common abnormalities associated
with urethral stones include foreign bodies, urethral
strictures, diverticula, and chronic infection (5,6). Like
this present, rarely it can be seen on absorbable suture after radical prostatectomy (7,8). Treatment of the
urethral stones mostly depends on the anatomic location and the width of the stone and on the associated
anatomical pathology of the urethra. Milking, forceps
extractions (manual or endoscopic) or basket, endoscopic push-back, electrohydraulic lithotripsy and surgery (internal urethrotomy, meatotomy, percutaneous
and open cystolitotomy) are the treatment options (2).
118
REFERENCES
1.
Paulk SC, Khan AU, Malek RS, et al. Urethral calculi. J Urol
1976; 116: 436-9.
2.
Verit A, Savas M, Ciftci H. Outcomes of urethral calculi patients
in an endemic region and an undiagnosed primary fossa navicularis calculus. Urol Res 2006; 34: 37-40.
3.
Kamal BA, Anikwe RM, Darawani H. Urethral calculi: Presentation and management. BJU Int 2004; 93: 549-52.
4.
Paulk SC, Khan AU, Makek RS, Grene LF. Urethral calculi. Urology 1976; 16: 436-40.
5.
Walker BR, Hamilton BD. Urethral calculi managed with transurethral holmium laser ablation. J Pediatr Surg 2001; 36: 16-7.
6.
Koga S, Matsuoka AM, Ohyama C. Urethral calculi. Br J Urol
1990; 65: 288-9.
7.
Cursio R, Choquenet C. Iatrogenic bladder stone formation on
absorbable suture 3-years after radical prostatectomy. Minerva
Urol Nefrol 2002; 54: 127-8.
8.
Miller JI, Clarck RL, Jennings CE, et al. Anastomotic stricture
with foreign-body reaction and stone formation following radical
retropubic prostatectomy. Urology 1992; 39: 417-9.
Akad Geriatri 2009; 1: 116-118