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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 51  |  Issue : 2  |  Page : 81-82

Can female urethral calculus present with acute urinary retention?


Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Submission06-May-2017
Date of Decision01-Jun-2017
Date of Acceptance27-Aug-2017
Date of Web Publication24-Apr-2018

Correspondence Address:
Dr. M S Faridi
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_74_17

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  Abstract 

Urethral calculus is a very rare cause obstructive uropathy. Incidence of urethral calculus is extremely rare, less often in females as compared to males. It is usually associated with genitourinary pathology. Primary or native urethral calculus, formed in situ in the urethra whereas secondary or migratory urethral calculi originate from the kidney or bladder and descend into urethra. Most of the primary urethral stones are formed in association with functional or anatomical pathology such as chronic stasis, urinary tract infection, urethral diverticulum, meatal stenosis, urethral stricture, periurethral abscess or fistulous tract. Diagnosis of urethral calculus is sometimes difficult due to its location, and failure of diagnosis may leads to urethral injury, urinary incontinence or renal insufficiency. We present a case of 50 years old woman with acute retention of urine. On genital examination stone was visible at the urethral meatus. On cysto-urethroscopy, no urethral abnormality was detected. On further ultrasound evaluation, no stone was visualised in the kidney or the bladder. Our case is distinct because no anatomic abnormalities were detected after complete urological evaluation.

Keywords: Female, urethral calculus, urinary retention


How to cite this article:
Mahele M, Faridi M S, Singh KS, Singh RS. Can female urethral calculus present with acute urinary retention?. Formos J Surg 2018;51:81-2

How to cite this URL:
Mahele M, Faridi M S, Singh KS, Singh RS. Can female urethral calculus present with acute urinary retention?. Formos J Surg [serial online] 2018 [cited 2020 Nov 30];51:81-2. Available from: https://www.e-fjs.org/text.asp?2018/51/2/81/231143


  Introduction Top


Urethral stones are quite rare and account for up to 2% of all urinary tract stones.[1] They are mostly seen in men due to the long and tortuous urethra and are rare in females. Urethral stones are classified into primary formed in the urethra in situ and secondary formed in the kidney or urinary bladder and descend into the urethra. Most primary urethral stones are associated with functional or anatomical pathology.[2] Urethral calculus can present as acute urinary retention, urethral pain, perineal and rectal pain, interrupted stream, poor stream with dribbling, and palpable mass in the urethra.[3] Urethral calculus in females without any anatomical abnormality is rare.


  Case Report Top


A 50-year-old female presented with acute urinary retention. On examination, vital signs were normal, but urinary bladder was palpable. There was no history of urolithiasis. On genital examination, the stone was visible at the urethral meatus [Figure 1]. Patient has X-ray kidney, ureter, and bladder (KUB) which showed radiopaque shadow below the pubic rami [Figure 2]. With all precautions, the stone was removed manually. No bleeding was noted after the procedure. On cystourethroscopy, no anatomical abnormality or urethral abrasion was noted. Moreover, no stone was seen in the urinary bladder. Ultrasound and KUB did not show any other stones in the urinary tract. The patient was discharged with normal voiding. The patient was followed up for 6 months without any voiding difficulty.
Figure 1: Calculus seen at urethral meatus

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Figure 2: X-ray kidney, ureter, and bladder showing 11-mm stone in urethra (arrow)

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  Discussion Top


Urethral stones are rare and account for 0.3%–2% of urinary tract calculi.[1] It is more common in man. Primary urethral calculus is extremely rare and often associated with stricture or urethral diverticulum. Secondary calculi were more common, at least 10 times than the primary stones.[2]

Urethral calculus symptoms depend on its anatomical location. Anterior urethral calculus commonly presents with dysuria. Whereas, posterior urethral calculus presents with pain referred to rectum or perineum. Impacted urethral calculus can cause acute urinary retention.[4] Our patient presented with acute urinary retention with sensation of stone impacted in the urethra. X-ray KUB showed 11-mm calculus below the pubic rami. The diagnosis of secondary calculus was made because of the absence of urethral anomalies on cystourethroscopy. Although noncontrast computed tomography (CT) scan is regarded as the gold standard for urinary tract calculi,[5] the initial radiological investigation is plain X-ray KUB. However, CT scan could not be done in this patient to look for any other stones in the urinary tract due to financial constraints.

The treatment aim is to remove the urethral calculus without any complications and to relieve the obstruction of the urinary tract. Due to the rarity of urethral stone occurrence, its treatment has not been well defined. Stones up to 10 mm could pass spontaneously. Treatment options for posterior urethral calculus include pushing back the calculus into the bladder for subsequent in situ lithotripsy or open surgery. The success rate for the above procedure is around 86%.[3] Large distal calculi could be managed with urethral meatotomy or open surgery. Urethroplasty is preferred.[6],[7] Manual extraction of the stone should be done gently by an experienced urologist as the abrasive surface of the calculi may damage the delicate urethral mucosa and increases the possibility of subsequent stenosis.[8] We also tried manual removal of urethral calculus with utmost care.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Verit A, Savas M, Ciftci H, Unal D, Yeni E, Kaya M, et al. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus. Urol Res 2006;34:37-40.  Back to cited text no. 1
    
2.
Thomas JS, Crew J. Obstructing urethral calculus in a woman revealed to be the cause of chronic pelvic pain. Int Urogynecol J 2012;23:1473-4.  Back to cited text no. 2
[PUBMED]    
3.
Kamal BA, Anikwe RM, Darawani H, Hashish M, Taha SA. Urethral calculi: Presentation and management. BJU Int 2004;93:549-52.  Back to cited text no. 3
[PUBMED]    
4.
Shim JS, Oh MM, Kang JI, Ahn ST, Moon du G, Lee JG, et al. Calculi in a female urethral diverticulum. Int Neurourol J 2011;15:55-7.  Back to cited text no. 4
    
5.
Bielawska H, Epstein NL. A stone down below: A urethral stone causing acute urinary retention and renal failure. CJEM 2010;12:377-80.  Back to cited text no. 5
[PUBMED]    
6.
Selli C, Barbagli G, Carini M, Lenzi R, Masini G. Treatment of male urethral calculi. J Urol 1984;132:37-9.  Back to cited text no. 6
    
7.
Noble JG, Chapple CR. Formation of a urethral calculus around an unusual foreign body. Br J Urol 1993;72:248-9.  Back to cited text no. 7
    
8.
Okeke LI, Takure AO, Adebayo SA, Oluyemi OY, Oyelekan AA. Urethral obstruction from dislodged bladder diverticulum stones: A case report. BMC Urol 2012;12:31.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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