Hello François,

Quelques idées à chercher si pas encore fait : phosphatémie basse ? calcémie normale ou haute ? 1,25 OH vitamine D élevée ?: rechercher une cause de fuite de phosphate (brushite et carbapatite) : hyperpara primaire, diabète phosphaté ?.

Acidose métabolique ? (acidose tubulaire distale ?).

TDM pour éliminer une pyélite incrustante ? (corynebacterium urealyticum qui nécessite ECBU avec culture longue chez un patient peut être immunodéprimé : cortico au long cours ?)

Amitiés,

Lucile

Salut , et merci beaucoup.

Je vais tout reprendre, dans les orientations que tu donnes, en effet. Nous avions déj)à fait toutes ces recherches en 2014 et 2015 , sans succès. Pour la corynae, j'en ai eu une , et je cours après depuis quatre ans, y compris avec des ECBU peropératoires durant la fragmentation LASER.. Il est en effet sous cortico au long cours et prend un anti TNF alpha pour son rhumatisme inflammatoire...

Cela vaudra mieux que de se jeter sur une prostaectomie totale; qui risque de ne pas traiter une des causes que tu évoques. 

J'avais évoqué l'alkaptonurie, qu'en dis tu ?

Merci pour ton aide en tous cas, et bonjour à monsieur !

Amitiés.

François

Hi Luyckx,

As you know, postoperative recurrence of prostatic calculi may be observed if related diverticula are not excised or obliterated. Despite de novo calculi may subsequently form in the remaining cavities of the prostate gland, false recurrences which represent calculi that were overlooked at the time of the original operation may be subsequently identified. 

I guess the rapid growth of postop. obstructing adenoma may indicate that all the previously performed TURPs were not complete to the anatomical capsule, so that, considerable residual adenoma may predispose to subsequent stone formation.

Surprisingly, the stones are formed in the prostatic bed or detected there, especially after complete HoLEP !!

Beside the excellent workup suggested by Dr. Figueres, I guess this patient may need full UDS to exclude the neurogenic bladder element, which may precipitate new stone formation, aggravated by recurrent UTI.

Regards 

Hi Elkoushy.

Thank you for your answer.

Bladder emptying was complete during the first two months after HoLEP. Obstruction reappeared after stone formation...

No proof of infection for the moment

Regards.

François

I would culture urine for ureaplasma urealyticum.

At next cystoscopy, culture stone or stones removed for aerobic, anerobic and ureaplasma organisms.

Consider staph epidermidis that occasionally is a urea splitter.

OK, I'll check it.

Thank you, Antolak.

Please  tellme the culture results. [email protected]

If I can suggest that, you should investigate for another origin of calculi, although it is very rare, the seminal vesicles. The calculi may be extruded from the ejaculatory ducts which may be still connecting the prostatic bed.

thanks

• Well, thank you for the post.

As far as I know, whenever, necrosis occurs it can lead to calcification. All the procedures that has been done to the patient focused to make necrosis in the prostatic tissue. Now, each time, a certain portion of the tissue destroyed and consequently, cells died and got calcified likely in a laminated fashion. This might vary based on the prostatic tissue, any comorbidity with prostate, any urinary infection (acute prostatitis vs. chronic) in the past, or several other factors. It was an interesting case. I think we can do an evidence-based study like prospective cohort on that. Thank you.

Dear,

I understand. But I performed (once only) lithotripsy alone. The recurrence was the same.

OK to write something with you and all others that had such cases to manage.

Thank you.

François

 Check the pH and acidify the urine.may be start on nitrofurantoin profylaxis.