A Giant in a Small Tunnel: Giant Prostatic Urethral Calculus Presenting as Continuous Urinary Incontinence in a Young Male

Abstract

Prostatic calculi are commonly encountered and usually asymptomatic. However, giant prostatic urethral calculi are rare and typically present with obstructive lower urinary tract symptoms. Here, we report a 31-year-old unmarried male presenting with continuous urinary dribbling without normal voiding for 2 months. Examination revealed a stony hard area on digital rectal examination. Imaging demonstrated bilateral hydroureteronephrosis, a large vesical calculus, and multiple prostatic urethral calculi. Renal dysfunction and urinary infection were also present. Endoscopic evaluation confirmed the findings. Due to the large bladder calculus, open cystolithotomy was performed. Prostatic calculi could not be extracted directly; hence, a combined antegrade and retrograde lithotripsy approach was employed successfully. Postoperatively, renal parameters normalized, and the patient regained normal voiding with preserved continence. Giant prostatic calculi are rare and typically present with obstruction; however, this case report highlights an unusual presentation with incontinence. A tailored combined surgical approach can achieve favorable outcomes.