A uretheral stone causing urinary obstruction in a paediatric patient

Urinary retention in pediatric patients is an uncommon presentation, particularly when attributed to urethral stones. We present the case of an 8 year old child who experienced acute urinary retention due to a urethral stone, an infrequent occurrence in this age group. Initial assessment revealed signs of obstructive voiding, prompting further investigation. Imaging studies confirmed the presence of a urethral stone causing complete obstruction. Management involved a multidisciplinary approach, incorporating surgical intervention. This case report underlines the need for awareness about the rare occurrence of urethral stones in pediatric age group which must be kept in mind while treating children.

Treatment of giant prostatic urethral stone with prostatolithotomy case report

INTRODUCTION

The patient with prostatic urethral stones of the size mentioned in the case report is very rare, and there is no standard surgical procedure for patients with giant stones in the prostatic urethra.

PRESENTATION OF CASE

A 62-year-old male patient presented to the emergency department with complaints of dysuria and hematuria. Computed tomography showed a prostatic urethral stone measuring 78x48x56 mm. Open prostatolithotomy was performed by extending the bladder incision towards the prostate capsule and the stone was removed.

DISCUSSION

Prostate stones can be classified into two types: true prostate stones, which form within the prostate's tissues, and urethral stones, which develop in the prostatic urethra. Urethral stones can be primary (forming in the urethra) or secondary (migrating from the upper urinary tract).

CONCLUSION

Treatment options vary based on stone size and patient history, with endoscopy recommended as the primary approach. However, in cases with large stone burdens, open surgical methods may be preferred.

Giant long-standing urethral calculus without urinary retention: A case report

INTRODUCTION AND IMPORTANCE

In this case report, we found a giant urethral stone that lasted for ten years without urinary retention and was admitted to the hospital with a non-urinary main complaint.

CASE PRESENTATION

We reported a 53-year-old patient, initially admitted to the emergency room because of decreased consciousness. Notably, the patient also presented with a bulged suprapubic area. Careful examination of the external genitalia pointed to palpable, large-sized calculus proximal to the external meatus. The patient's relatives acknowledged that the stone had been present for ten years, but he could void it spontaneously before admission. The imaging series (KUB X-Ray, Head CT, TAUS) confirmed the diagnoses of brain hemorrhage, bilateral hydronephrosis, and a stone at the navicular fossa. Sequential extra-ventricular drainage and dorsal meatotomy were performed under general anesthesia, resulting in a good local condition. We successfully extracted 4 × 2 cm calculous from the patient's urethra, and the hydronephrosis resolved after the extraction.

CLINICAL DISCUSSION

The patient has mild hydronephrosis due to chronic urinary retention and LUTS from the giant urethral stone. The stroke to the dominant hemisphere and insula could lead to acute urinary retention, which worsens hydronephrosis. Immediate diversion of urine by taking stones from the anterior meatus urethra can improve the patient's hydronephrosis condition.

CONCLUSIONS

This report demonstrated an interesting case of an impacted giant urethral stone in a critically ill male patient without urinary retention before admission. Prompt evaluation and management are required and should prioritize conditions predisposing patients to severe complications.

Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones

OBJECTIVES

To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm.

PATIENTS AND METHODS

This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia.

RESULTS

The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required.

CONCLUSIONS

ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.

Giant urethral stone presenting as a scrotal mass: Case report

Primary urethral stones are a rare form of urolithiasis accounting for less than 0.3% of urinary stones. We are reporting a case of a giant primary urethral stone that developed in the penile urethra resulting from a post-surgical complication of urethral stricture. The patient presented with difficulty urinating, ejaculatory dysfunction, and a hard palpable scrotal mass.