British Journal of Urology (1998), 81, 645–646

CASE RE PORT

Gross calcification within the prostate glandJ . STUART TAYLORNewcastle, New South Wales, Australia

Gross calcification and calculus formation is arbitrarilyCase reports

defined here as that which occupies an area of >3 cm2

on a standard X-ray of the pelvis (Fig. 1); such calcifi-Three men (aged 57, 69 and 60 years) presented withmoderately severe prostatism. The first patient had a cation is rare at any age.

It is generally agreed that the fundamental changeshistory of severe prostatitis at age 18 that requiredseveral weeks of hospitalization; prostatic calcification leading to the formation of prostatic calculi are obstruc-

tion within the prostatic ducts, with subsequent stasis ofwas diagnosed shortly afterward. Cases 2 and 3 did nothave a relevant past history but both had hypercalciuria prostatic fluid, desquamation of acinar cells, then the

development of corpora amylacea and subsequent depos-and were subsequently diagnosed as having hyperpara-thyroidism due to a parathyroid adenoma and renal ition of hydroxyapatite on the latter. Prostatitis may lead

to this course of events and is recognized as a predispos-hypercalciuria, respectively. The initial treatment wasTURP using a standard diathermy loop and continuous- ing cause. Prostatic calculi have also been reported

in association with ochronosis [4], haemospermia [5],flow 24 F resectoscope sheath. Once the stones werevisualized, several methods were used to remove them. prostatic hypertrophy, hyperplasia and carcinoma [2],

after radiotherapy for carcinoma of the prostate [6] andThe smaller stones were manipulated into the bladderthen aspirated out through the resectoscope sheath. The after prostatectomy [7]. A Medline literature search for

1966–1996 inclusive found no reports of prostatic cal-larger stones were either manipulated into the bladderand fragmented there with a standard lithotrite, or in culi in association with hyperparathyroidism or hyper-

calciuria. Interestingly, in both cases calcificationthe most recent case were fragmented in situ in theprostate using a lithoclast. Once the surface of the stone recurred until the conditions were controlled and then

it ceased. All patients are now free of their originalwas exposed, this latter technique was a very eCectivemeans of fragmentation, the fragments again being symptoms of prostatism. Recurrent dystrophic calcifi-

cation in a prostate gland previously aCected by grosswashed into the bladder and then aspirated out.No new stones developed in the patient with the calcification is an indication for appropriate metabolic

investigations.history of prostatitis but dystrophic calcification recurredthree times in 3 years in the patient with hyperparathy-roidism, and on one occasion osseous change was notedon histological examination in some of the prostaticchips. The parathyroid adenoma was then removedwith no subsequent recurrence of prostatic calcification.Calcification recurred once in the patient with renalhypercalciuria, the latter condition responding tohydrochlorthiazide. Since his urinary calcium excretionbecame normal, there has been no recurrence ofcalcification.

Comment

Prostatic calculi are rare in children, infrequent in menyounger than 40 years, but common after the age of 50years [1]. The exact incidence depends upon the tech-nique used to detect them, being 7% by histologicalexamination of operative specimens [2] but 99% in

Fig. 1. Plain X-ray illustrating gross prostatic calcification.autopsy specimens examined by imaging techniques [3].

645© 1998 British Journal of Urology

646 CASE REPORTS

Transrectal ultrasound in the investigation of haemospermia.ReferencesClin Radiol 1990; 41: 175–71 Klimas R, Bennett B, Gardner WA. Prostatic calculi; a

6 Keys HM, Reed W. Severe prostatic calcification afterreview. Prostate 1985; 7: 91–6radiation therapy for cancer (letter). J Urol 1980; 123: 135–62 Cristol DS, Emmett JL. Incidence of coincidental prostate

7 Hemal AK, Sharma SK. Giant vesico-prostatic and prostaticcalculi, prostatic hyperplasia and carcinoma of the prostate.calculi. Trop Geog Med 1989; 41: 164–6.JAMA 1944; 124: 646–52

3 Sonderagaard G, Vetner M, Christensen PO. Prostatic calculi.Acta Pathol Microbiol Immunol Scand 1987; 95: 141–5

Author4 Strimer RM, Morin LJ. Renal, vesical and prostatic calculiassociated with ochronosis. Urology 1977; 10: 42–3 J. Stuart Taylor, FRCS(Eng), FRCS(Ed), FRACS, Urologist, 19

Bolton Street, Newcastle, New South Wales, Australia.5 Etherington RJ, Clements R, GriBths GJ, Peeling WB.

© 1998 British Journal of Urology 81, 645–646