Prostatic calculi are classified into two types, endogenous and exogenous calculi, based on their origin. Endogenous calculi are commonly observed in elderly men; however, exogenous prostatic calculi are extremely rare. We report here the case of a 51-year-old man who suffered incontinence and pollakiuria with a giant exogenous prostatic calculus almost completely replacing the prostatic tissue. X-rays and computed tomography demonstrated a large calculus of 65 × 58 mm in the small pelvic cavity. The patient underwent a transurethral lithotripsy with a holmium-YAG laser and a total of 85 g of disintegrated stones was retrieved and chemical stone analysis revealed the presence of magnesium ammonium phosphate. The incontinence improved and the voiding volume increased dramatically, and no stone recurrence in the prostatic fossa occurred at the 2 years follow-up. The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra.
Serious complications have not been previously reported during seed implantation for prostate brachytherapy. We present an unreported case of rectal injury caused by an ultrasound probe. A 67-year-old male presented with a serum prostate-specific antigen level of 5.50 ng/ml, a Gleason score of 7 (3 þ 4) and clinical T2a adenocarcinoma of the prostate. A transperineal permanent prostate brachytherapy implantation was performed. The patient subsequently complained of abdominal pain postoperatively. A gastrointestinal perforation was suspected based on an abdominal X-ray obtained on the day after the brachytherapy. Rectal injury was recognized during an exploratory laparotomy, and a primary closure and temporary diversion ileostomy were performed. The healing of the injury was confirmed by colonoscopy and an ileostomy closure was performed 2 months after the temporary diversion. The investigating committee for this accident concluded that the ultrasound probe had perforated the rectum. This is the first case of a rectal injury during seed implantation for prostate brachytherapy.
A prolonged course of oral tripotassium dicitratobismuthate (De‐Noltab) was administered to an elderly woman. The patient developed extrapyramidal neurological symptoms and subsequently sustained accidental fracture of the right neck of the femur before bismuth toxicity was identified. The parkinsonian features that presented in this patient were thought to be possibly related to the accumulation of bismuth in the basal ganglia as a result of the long term ingestion of tripotassium dicitratobismuthate.
Prolonged treatment with the drug should be discouraged and repeat prescriptions should always be queried.
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