Mechanisms of Delayed Lower Urinary Tract Stone Formation

Main Article Content

Fawad Arif
West Alaiyi


Materials and methods:
We analysed Holmium Laser Enucleation of Prostate (HOLEP) database consisting of 1300 patients who presented more than 18 months after undergoing the procedure with lower urinary tract symptoms (LUTS-voiding lower urinary tract symptoms, dysuria, haematuria, recurrent urinary tract infections-UTIs) second-ary to delayed lower urinary tract stone formation. Information was gathered from the case notes, imaging modalities, operation notes and pathology reports.

Three patients were identified who presented with delayed lower urinary tract stone formation 18 months after undergoing HOLEP.

Case 1: A 68-year-old presented with a 4-cm mobile bladder stone on a retained prostatic fragment 29 months after HOLEP.
Case 2: A 74-year-old presented with 2.5 cm bulbar urethral stone 18 months after HOLEP.
Case 3: A 77-year-old presented with dystrophic calcification of the entire prostatic fossa 60 months after HOLEP.

Delayed lower urinary tract stone presentation is unusual after HOLEP. Recurrent urethral pain, recurrent UTI, gross haematuria and voiding lower urinary tract symptoms in the presence of a lower urinary tract stone (bladder, prostate and urethra) with a radiolucent centre on a background of HOLEP should raise the suspicion that this may represent calcification on a prostatic tissue fragment or dystrophic calcification of the residual prostate/prostatic fossa. Careful morcellation, inspection of the prostatic fossa on withdrawing the morcellator  for large residual prostate fragments still attached to the prostatic bed/bladder neck or simply stuck to the fossa (usually in a clot) will reduce the risk of retainment of such a significant prostatic fragment that can potentially cause complications in the future.



Download data is not yet available.

Article Details

How to Cite
Arif, F., & Alaiyi, W. (2021). Mechanisms of Delayed Lower Urinary Tract Stone Formation . Journal of Endoluminal Endourology, 4(1), e17-e22.
Original Article
Author Biographies

Fawad Arif, South Tees Hospitals NHS Foundation Trust, UK

South Tees Hospitals NHS Foundation Trust, UK

West Alaiyi, South Tees Hospitals NHS Foundation Trust, UK

South Tees Hospitals NHS Foundation Trust, UK


1. Tooher R, Sutherland P, Costello A, et al. A systemic review of holmium laser prostatectomy for benign prostatic hyperplasia. J Urol. 2004;171:1773. https://
2. Lee J, Oh J. Calculi in the prostatic surgical bed as a complication after holmium laser enucleation of the prostate. J Urol. 2018;15(5)238–41.
3. Elzayat EA, Habib E, Elhilali MM. Holmium laser enucleation of the prostate: A size-independent new “gold standard”. Urology. 2005;66:108–13. https://doi. org/10.1016/j.urology.2005.06.006
4. Hettiarachchi JA, Samadi AA, Konno S, Das AK. Holmium laser enucleation for large (greater than 100 mL) prostate glands. Int J Urol. 2002;9:233–6. https://
5. Suardi N, Gallina A, Salonia A, Briganti A, Deho F, et al. Holmium laser enucleation of the prostate and holmium laser ablation of the prostate: Indications and outcome. Curr Opin Urol. 2009;19:38–43. https://doi. org/10.1097/MOU.0b013e32831a7008
6. Sung HK, Changwon Y, Ninsoo C, et al. Factors affecting de novo urinary retention after holmium laser enucleation of prostate. PLoS One. 2014;9(1):e84938.
7. Kuntz RM, Ahayi S, Lehrich K et al. Transurethral hol-mium laser enucleation of prostate versus transurethral electrocautery resection of the prostate: A randomised prospective trial in 200 patients. J Urol. 2004;172:1012.
8. Ahyai SA, Lehrich K, Kuntz RM. Holmium laser enucleation versus transurethral resection of prostate: 3-year followup results of a randomised clinical trial. Eur Urol. 2007;52:1456. eururo.2007.04.053
9. Elzayat EA, Elhilali MM. Holmium laser enucleation of prostate (HOLEP): The endourological alternative to open prostatectomy. Eur Urol. 2006;49:87. https://
10. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enu-cleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160.
11. Gillin PJ, Aho TF, Frampton CM, et al. Holmium laser enucleation of the prostate: Results at 6 years. Eur Urol. 2008;53:744. eururo.2007.04.052
12. Elzayat EA, Elhilali MM. Holmium laser enucleation of the prostate (HOLEP); longterm results, reoperation rate and possible impact of learning curve. Eur Urol. 2007;52:1465. eururo.2007.04.074
13. Merchant SA, Amonkar PP. Genitourinary Bilharziasis: A review. Indian J Radiol Imaging. 2002;12(2):239–44.
14. Dyer RB, Chen MYM, Zagoria RJ. Abnormal calcifications in the urinary tract. Radiographics. 1998;18(6):1405–24. 15. Tsujimura A, Imazu T, Nishimura K, et al. Ureteropelvic
junction obstruction with renal pelvic calcification: A case report. J Urol. 1993;150(6):1889–90. https://doi. org/10.1016/S0022-5347(17)35925-6
16. Valentin Z, Patrick B, Gaiter M, et al. Recurrent dys-trophic calcification of the prostatic resection cavity after transurethral resection of the prostate: Clinical presentation and endoscopic management. J Endourol Case Rep. 2017;3(1):81–3. cren.2017.0058
17. Jeon SW, Park YK, Chang SG. Dystrophic calcification and stone formation on the entire bladder neck after potassium-titanyl phosphate laser vaporization for the prostate: A case report. J Korean Med Sci. 2009;24:741–3.
18. Tasci AI, Tugcu V, Ozbay B, Mutlu B, Cicekler O. Stone formation in prostatic urethra after potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia. J Endourol. 2009;23:1879–81.
19. Dru C, Bender L. Dystrophic calcification of the prostate after cryotherapy. Case Rep Urol. 2014;2014:471385.
20. Jones WA, Miller EV, Sullivan LD, et al. Severe pro-static calcification after radiation therapy for cancer. J Urol. 1979;121(6):828–30. S0022-5347(17)57011-1
21. Gross AJ, Netsch C, Knipper S, Holzel J, Bach T. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: Results at a single institution. Eur Urol. 2013;63:859–67.