Jackstone Calculus

Abstract

A 75-year-old man presented with a 3-year history of poor urinary flow, recent hematuria, and urgency. He had been taking α-blockers for more than 10 years for lower urinary tract symptoms. He was a nonsmoker. Computed tomography revealed normal kidneys and ureters but a large intravesical extension of the prostate gland and calculi with a spiculated pattern (Figure 1A and B), characteristic of jackstone calculi. Cystoscopic examination revealed calculi with multiple spicules and characteristic dark bands (Figure 2). He underwent cystoscopy-guided laser lithotripsy, with complete fragmentation via holmium laser. He also had concurrent transurethral resection of the prostate gland. Postoperatively, he voided with a good stream.Figure 2Cystoscopic image showing jackstone calculi in the bladder.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Jackstone calculi are bladder calculi composed of calcium oxalate dihydrate, which gives them their irregular shape.1Singh K.J. Tiwari A. Goyal A. Jackstone: a rare entity of vesical calculus.Indian J Urol. 2011; 27: 543-544Google Scholar They get their name from their resemblance to toy “jacks” with multiple spicules. Bladder calculi are an important consideration in the differential diagnosis in older patients with hematuria and are often secondary to prostatic obstruction.2Douenias R. Rich M. Badlani G. Mazor D. Smith A. Predisposing factors in bladder calculi: review of 100 cases.Urology. 1991; 37: 240-243Google Scholar Primary care physicians should be aware of their characteristic appearance on plain radiography. It is imperative, however, to perform contrast-enhanced computed tomography of the abdomen and pelvis and a thorough cystoscopic examination to rule out malignancy as cause of the hematuria.