Preputial calculus in a neurologically-impaired child

Abstract

Background: Preputial calculi are rarely encountered in childhood.Case characteristics: A 5-year-old boy with symptoms of chronic balanoposthitis. Observation: A preputial stone was documented and removed at circumcision. Outcome: Uneventful postoperative recovery. Message: In children, association between phimosis and neurologic impairment represent predisposing condition for preputial stone formation.

Giant Preputial Calculus: The First Reported Case in Malaysia

“…This sac at the same time acts as a static reservoir for stone accumulation with metabolic action of urinary salt. It is common for stone to form in the prepuce especially among those with neurologic impairment and paraparesis or paraplegia as what has happened to our patient [ 4 – 6 ]. Moreover, urinary tract infection also precipitates stone formation particularly struvite type due to urease-producing bacteria [ 5 ].…”

Incidental Detection of Preputial Calculus in a Patient with Partial Phimosis: Is it as Rare as We Believed?

“…Previously published reports derive from underdeveloped countries, especially from India [3]. In European literature, there is scarce evidence for this specific type of urolithiasis [4][5][6]. To the best of our knowledge, our report is the fourth PSD in Europe.…”

“…Approaching the pathogenesis of PSD, we recognize three different types of preputial calculi: (a) those originating from inspissated smegma with lime salts, (b) calculi originating from precipitation of urinary salts because of urinary retention in the preputial cavity, which may be accompanied by an infection usually caused by urea-splitting bacteria, and (c) migratory calculi from the upper urinary tract to the preputial sac [1,5,7]. Regarding their composition, preputial stones consist of inspissated smegma, smegma and urinary salts or urinary salts alone [3].…”

“…Common presenting symptoms range from voiding difficulties, foul-smelling penile discharge, and chronic balanoposthitis to penile pain and acute urinary retention [2,5,7,8,9]. Neglected preputial stones can also lead to fistula formation in the preputial skin and even more seriously in penile cancer [4,8].…”

“…Considering the above, dorsal slit incision or circumcision represent the surgical approaches for definitive treatment, thus permitting stone removal and elimination of the precipitating cause [1,4,5].…”