Giant Preputial Calculus: The First Reported Case in Malaysia

Abstract

Preputial calculus is a relative surgical rarity. It usually happens in elderly men with poor hygiene and uncircumcised penis complicated with phimosis. In the paediatric group, it is usually secondary to phimosis and other urologic and/or neurologic anomalies. Surgical treatment is the mainstay of treatment. Herein, we report a 27-year-old gentleman with preputial stone presented with obstructive uropathy and was successfully treated with surgical intervention. To the best of our knowledge, this is the first reported case of the largest preputial stone in Malaysia.

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

“…Similarly, to our case, in 1997, Sonnex et al described the presence of three preputial calculi consisting of smegma in a 24-year old patient with a partially retractable foreskin and coexistent balanoposthitis [6]. The number and size of stones usually vary, while there is a predominance in uncircumcised adults or elders with severe phimosis [1,2,7]. Less commonly, the condition may appear in uncircumcised children with coexistent urologic or neurologic diseases [2].…”

“…The number and size of stones usually vary, while there is a predominance in uncircumcised adults or elders with severe phimosis [1,2,7]. Less commonly, the condition may appear in uncircumcised children with coexistent urologic or neurologic diseases [2]. Low socioeconomic status and poor hygiene are secondary risk factors, as confirmed in our case [4].…”

“…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].…”

“…Preputial stone disease (PSD) remains an exceptionally under-reported type of urolithiasis since its first presentation by Robert Clarke in 1794 [1]. It occurs mainly in adult males and less often in children with coexistent urologic or neurologic diseases [2]. The primary causal factor leading to the development of preputial stones is severe phimosis [1].…”