# Preputial Calculus: Unveiling a Rare Encounter and Treatment Journey

## TL;DR

A rare case of preputial calculus in an elderly man is reported, highlighting its diagnosis and treatment through surgery.

## Contribution

This is the first reported case of the largest preputial stone in an elderly individual in rural central India.

## Key findings

- Preputial calculus can present with obstructive uropathy and palpable preputial masses.
- Surgical intervention via circumcision and stone removal effectively managed the condition.
- The case highlights the rarity and unique presentation of preputial calculus in elderly populations.

## Abstract

Preputial calculus is an infrequent manifestation of urolithiasis, primarily observed in ageing individuals with an uncircumcised penis and not maintaining proper hygiene, which can further be complicated by co-morbidities such as phimosis. On the contrary, phimosis and other neurological/urological malformations have also been reported in children to cause preputial calculus. Overall clinical presentations include a palpable mass within the prepuce, dysuria, hematuria, obstructive uropathy, diminished urine flow, and malodorous discharge. This is a case of a 65-year-old male presented with a complaint of obstructed urinary flow. The patient was diagnosed with obstructive uropathy due to the presence of preputial stone/s. This case illustrates both singular and multiple stones in the affected patient. The patient was managed by surgical intervention by circumcision followed by calculus removal. As per the available published literature, this case can be noted as the first report of the largest preputial stone in an elderly in any rural setup of central India.