Case profile: Spontaneous passage of large urethral calculus

OJOLOC'

CASE PROFILE : SPONTANEOUS PASSAGE OF LARGE URETHRAL CALCULUS

PROFILE

An eighty-nine-year-old black woman with dementia was referred to our emergency room from a nursing home with what was described as a yellow vaginal discharge . Upon examination, a large yellowish stone was found to be protruding through the urethra into the vagina . The stone could not be dislodged either back into the bladder or further out of the urethra . The patient was noted to be voiding around the stone and had no bladder distention . A KUB film (kidney-ureter-bladder) showed no other calculi present (Fig . 1) . Laboratory studies

FIGURE 2 .

Large urethral calculus passed monta-

neously. were normal except for an hematocrit of 23 .0 due to chronic anemia . It was elected to prepare the patient for open lithotomy, and over a two-day period she received two units of blood raising her hematocrit to 32 . On the evening prior to surgery, however, the stone was passed and recovered by the nursing staff (Fig . 2) . A follow-up KUB fil]n confirmed the lack of further urinary calculi, and examination revealed a widely dilated urethra . One week later, the urethra had contracted to normal size .

FIGURE 1 .

UROLOGY

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Initial KUB film .

JANUARY 1986

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VOLUME XXVII, NUMBER 1

James M . Cummings, M .D . (Reprints) Raul Parra, M .D . John G . Gregory, M .D . Section of Urology St . Louis University School of Medicine St . Louis, Missouri 63104