1 answer

A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These...

Question:

A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms improved over the week and the urine microscopy report revealed no growth but large quantities of white and red blood cells.ReviewThe patient was reviewed at 10 days and was asymptomatic. A repeat urine microscopy was normal. At the review appointment, digital rectal examination revealed a non-tender benign prostatic enlargement. Biochemical tests including a PSA, glomerular filtration rate and U+Es were normal. Three weeks later he presented with frank hematuria and incontinence with lower abdominal and left-sided loin pain. He had a palpable bladder and a large stone trapped at the urethral entrance. He was admitted as a surgical emergency and underwent a meatotomy and stone removal under anesthesia. A cystoscopy was normal and there was no evidence of further calculi in the renal tract. The stone was calcium oxalate and thought to have originated from the ureter. A coexistent UTI had caused urethral impaction secondary to epithelial slough and an element of BPH. He has been well since.

Please provide a rationale with the answer.

What is the prevalence of ureteral stones?


Answers

Uretral stone refers to the presence of stone in the ureter ( one or both).The common stones formed are calcium,oxalate,uric acid stones. The prevalence rate of uretral stone is 1 in 20 in US.This patient has developed uretral stones because of UTI ,age (above 50 years).The prevalence of BPH increased when the stone deposited in the urethral pathway because of the epithelial slough.The difficulty in passing urine due to a block,which later due to continuous pressure lead to bleeding or heamaturia.Another important reason for this condition of the patient is the effect of Ciprofloxacin .Studies suggest the occurrence of crystal induced kidney injury due to ciprofloxacin. This forms the major reason for calcuk formation

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