Postoperative Encrusted Cystitis After Robot-Assisted Simple Prostatectomy: A Case Report

Encrusted cystitis is an uncommon disorder characterized by adherent mineral deposits on inflamed bladder mucosa.We report a 73-year-old man with persistent dysuria, hematuria, urinary frequency, weak stream, and fluctuating pyuria after robot-assisted simple prostatectomy.Day 1 denotes the first diagnostic cystoscopy.Cystoscopy showed extensive encrustation involving the prostatic surgical bed, bladder neck, and nearly all bladder walls; computed tomography demonstrated mural calcification and bladder-wall thickening.Urine pH reached 8.80 on day 15.Transurethral resection and debridement on day 16 removed more than 15 cm² of visibly involved mucosa.Histopathology showed inflammation and calcium deposition, and analysis of the removed encrustations identified calcium phosphate (apatite).A bladder aspirate grew Enterococcus faecalis at 100,000 colony-forming units/mL.Corynebacterium urealyticum was not isolated after 72-hour incubation on standard media or detected in the removed deposits; targeted molecular testing was unavailable.The cause of the encrustation therefore remained unconfirmed, with both an infectious mechanism and postoperative dystrophic calcification considered.Treatment included debridement, temporary urinary drainage, susceptibility-supported levofloxacin, a 14-day empirical course of intravenous vancomycin, and eight weeks of oral L-methionine.No infusion reactions or serious systemic adverse effects were recorded.Follow-up urine cultures were negative.Cystoscopy on day 117 showed no visible encrustations, although mucosal inflammation remained.By day 131, symptoms had improved substantially, with the International Prostate Symptom Score decreasing from 22 to 6, while pyuria persisted.This case illustrates the need to investigate a structural cause of persistent urinary symptoms after prostate surgery and to distinguish the diagnosis of encrusted cystitis from confirmation of its etiology.Improvement followed combined treatment; the separate contributions of empirical vancomycin and urinary acidification could not be determined.