Urethral calculi

We present 56 patients with urethral calculi. In males the commonest location was the posterior urethra; 46 patients complained of dysuria but urinary retention was present in only 7. In 9 patients with penile urethral calculi, 6 had associated urethral disease (urethral stricture in 5 and urethral diverticula in 1). Transurethral litholapaxy or lithotripsy after retrograde manipulation was performed in 33 patients. Endoscopic manipulation was found to be the safest procedure.     

Urethral calculi: presentation and management

OBJECTIVE: To determine the occurrence, symptoms, treatment and outcome in patients with urethral stones. PATIENTS AND METHODS: Fifty-one consecutive patients with urethral calculi were assessed prospectively; all were male and one was an infant. RESULTS: Acute retention of urine occurred in 78% of patients, urethral anatomical pathology in 6% and posterior urethral calculi in 88%. The urethral stones, solitary in each patient, consisted of calcium oxalate in 86%, struvite in 6%, mixed stones in 4%, calcium phosphate in 2% and uric acid in 2%. A methodical approach to therapy was used which aimed to clearly define the circumstances in which a given procedure was used, and the resulting success rate. CONCLUSION: The common belief that most urethral calculi in patients in developing countries originate from the bladder does not seem to be generally applicable. Urethral anatomical pathology does not seem to be a necessary condition for most of these calculi.     

Urethral calculi managed with transurethral Holmium laser ablation

In situ Holmium laser lithotripsy is a safe, effective procedure for the treatment of impacted urethral stones. This procedure can be performed transurethrally as an outpatient with minimal tissue trauma and render patients stone free. The authors utilized this procedure in 2 patients whose anatomy did not allow the calculi to be manipulated into the urinary bladder in a retrograde manner. Because of its successful use elsewhere in the urinary tract, we believe that Holmium laser lithotripsy may be the treatment of choice for impacted urethral stones.     

Urethral tuberculosis.

Tuberculous affection of the urethra is very rare. Herein we report 2 cases of urethral tuberculosis. One in a young married female who had isolated urethral involvement presenting as urethral caruncle and the second in a young male with urethral stricture complicated by fistulae and abscess in association with renal tuberculosis. The relevant literature is briefly reviewed.     

Urethral diverticulum with endometriosis.

A case of urethral diverticulum in a female patient with endometriosis in the diverticular wall is presented. Review of the recent urologic literature reveals no such case reported previously. The diverticulum was excised and the urethral walls were approximated, with uneventful postoperative recovery.     

Urethral diverticulum with lithiasis.

Urethral diverticulum, either congenital or acquired, is very rare and becomes symptomatic when complicated by infection and lithiasis. This paper reports on such a case that was cured by radical excision of the lesion.     

Urethral strictures in boys.

Our experience with urethral strictures in boys during a 15-year period confirms the findings of others that the most common etiology is iatrogenic. Traumatic and inflammatory strictures are rare. The congenital stricture differs fundamentally from acquired types of urethral strictures and would be termed more appropriately congenital urethral membrane. Urethral dilation and/or urethrotomy was unsuccessful in 47% of our patients, leading to secondary formation of a new stricture in 2 instances. However, urethroplasty was successful in 83% of our cases and seems to be indicated when 2 or more dilations are required.     

Urethral duplications in the male.

A classification of duplications of the male urethra has been presented together with our clinical experience. The commonest variety is epispadiac form which may be complete, incomplete or abortive. Less common are the hypospadiac forms and very much rarer are the spindle urethras where the bladder neck and also the distal urethra are single. The bifid urethra with pre-anal accessory track is relatively common but has often gone unrecognised.