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Giant urethral calculus in a 6-year-old girl
Journal of Pediatric Urology (2008) 4, 469e471
CASE REPORT
Giant urethral calculus in a 6-year-old girl F. Rivilla a,*, A. Luis a, D. Llanos b, A. Ruiz b a b
Department of Pediatric Surgery, San Carlos University Hospital, Martin Lagos s/n, Madrid 28040, Spain Department of Radiology, San Carlos University Hospital, Madrid, Spain
Received 2 April 2008; accepted 15 April 2008 Available online 17 June 2008
KEYWORDS Pediatric urolithiasis; Urethral stone; Urethra
Abstract Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. Primary urethral calculi are extremely infrequent in females. We describe a case of a giant urethral stone impacted in a 6-year-old girl. ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
We present the case of a 6-year-old girl with a 3-month history of pain, burning, intermittent haematuria, and incontinence alternating with urinary retention secondary to a large urethral calculus. This is a unique cause of obstructive uropathy and incontinence for several reasons. First, urethral calculi are extremely rare in Caucasian females [1]. Second, urethral stones in females are nearly always associated with underlying genitourinary pathology [2,3]; however, subsequent work up failed to reveal any strictures, diverticula or related processes.
Case report There was no previous history of urinary problems and an indwelling bladder catheter had not been used before. No abnormalities were found on clinical exploration. Haemogram and blood chemistry studies were within normal limits. Macroscopically the urine was grossly cloudy. Urine sediment showed 2200 polymorphs and 650 erythrocytes/
* Corresponding author. E-mail address: [email protected] (F. Rivilla).
mm, with a significant culture of Escherichia coli. Plain Xray of the abdomen demonstrated a large calculus between the pubic bones. Cystography and MRI revealed that the stone was located entirely within the urethra with a small intravesical component (Figs. 1 and 2). Ultrasound showed bilateral hydronephrosis. The stone was not visible on inspection of the introitus but under general anaesthesia it was just visible at the urethral meatus when proximal pressure was applied from the abdomen. Cystourethroscopy showed a diffusely inflamed urethra with a giant calculus which was partially impacted. The calculus was then dislodged from the urethral wall although it could not be pushed out or up into the urinary bladder. No diverticulum or meatal stricture was noted on the urethra. Surgery was performed via a suprapubic incision and the stone was removed through a small bladder wound. Urethral catheter drainage of the bladder was maintained for four days after surgery. The girl was discharged home the next day. The stone (Fig. 2) was dirty yellow with a granular surface, hard, 58 25 21 mm in size, and 34 g in weight. Analysis revealed urate and calcium phosphate as the components. Her postoperative course was uneventful. After 4 months she achieved completed relief from any abnormal
1477-5131/$34 ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2008.04.007
470
F. Rivilla et al.
Figure 1 Radio-opaque shadow between the pubic bones represents the urethral stone which outlines the configuration of the female urethra (A). Retrograde cystourethrography showed a urethral stone (*) and severe deformities of the bladder neck and urethra (B).
urinary findings except a light bladder instability. Ultrasound revealed a total recovery from hydronephrosis.
Discussion Urethral calculi are infrequent and the majority are seen in male adults. Only 14 of 86 reported by Amin were in children less than 14 years of age and there were no females in the series [2]. The stones are usually secondary, and begin as vesical calculi or sometimes originate from the kidney. Calculi passing from the bladder may lodge in a diverticulum or may be due to a distal urethral stricture [2]. Primary calculus of the urethra is very rare and usually occurs in a congenital diverticulum [3,4]. A giant urethral calculus in such a young girl has, to our knowledge, not been reported previously. It seems surprising that this girl
Figure 2
presented in a relatively insidious manner. As to the aetiology, it would seem that the calculus formed primarily in the upper tracts and migrated to the urethra where it became impacted and enlarged.
Conflict of interest The authors have no conflict of interest.
Funding None.
Ethical approval Not applicable.
MRI revealed a large urethral calculus (*) extending into the bladder (A). Calculus after removal (B).
Giant urethral calculus
References [1] Maloney ME, Springhart WP, Ekeruo WO. Ethnic background has minimal impact on the etiology of nephrolithiasis. J Urol 2005; 173:2001e4.
471 [2] Amin HA. Urethral calculi. Br J Urol 1973;45:192e9. [3] Martinez A, Gonzalez C, Can ˜ada E. Giant calculus in a female urethral diverticulum. Int Urogynecol J 2000;11:45e7. [4] Sreedhar K, Singh SK, Mandal AK. Giant calculus in anterior urethral diverticulum. Urol Int 1992;48:117e9.
CASE REPORT
Giant urethral calculus in a 6-year-old girl F. Rivilla a,*, A. Luis a, D. Llanos b, A. Ruiz b a b
Department of Pediatric Surgery, San Carlos University Hospital, Martin Lagos s/n, Madrid 28040, Spain Department of Radiology, San Carlos University Hospital, Madrid, Spain
Received 2 April 2008; accepted 15 April 2008 Available online 17 June 2008
KEYWORDS Pediatric urolithiasis; Urethral stone; Urethra
Abstract Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. Primary urethral calculi are extremely infrequent in females. We describe a case of a giant urethral stone impacted in a 6-year-old girl. ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
We present the case of a 6-year-old girl with a 3-month history of pain, burning, intermittent haematuria, and incontinence alternating with urinary retention secondary to a large urethral calculus. This is a unique cause of obstructive uropathy and incontinence for several reasons. First, urethral calculi are extremely rare in Caucasian females [1]. Second, urethral stones in females are nearly always associated with underlying genitourinary pathology [2,3]; however, subsequent work up failed to reveal any strictures, diverticula or related processes.
Case report There was no previous history of urinary problems and an indwelling bladder catheter had not been used before. No abnormalities were found on clinical exploration. Haemogram and blood chemistry studies were within normal limits. Macroscopically the urine was grossly cloudy. Urine sediment showed 2200 polymorphs and 650 erythrocytes/
* Corresponding author. E-mail address: [email protected] (F. Rivilla).
mm, with a significant culture of Escherichia coli. Plain Xray of the abdomen demonstrated a large calculus between the pubic bones. Cystography and MRI revealed that the stone was located entirely within the urethra with a small intravesical component (Figs. 1 and 2). Ultrasound showed bilateral hydronephrosis. The stone was not visible on inspection of the introitus but under general anaesthesia it was just visible at the urethral meatus when proximal pressure was applied from the abdomen. Cystourethroscopy showed a diffusely inflamed urethra with a giant calculus which was partially impacted. The calculus was then dislodged from the urethral wall although it could not be pushed out or up into the urinary bladder. No diverticulum or meatal stricture was noted on the urethra. Surgery was performed via a suprapubic incision and the stone was removed through a small bladder wound. Urethral catheter drainage of the bladder was maintained for four days after surgery. The girl was discharged home the next day. The stone (Fig. 2) was dirty yellow with a granular surface, hard, 58 25 21 mm in size, and 34 g in weight. Analysis revealed urate and calcium phosphate as the components. Her postoperative course was uneventful. After 4 months she achieved completed relief from any abnormal
1477-5131/$34 ª 2008 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2008.04.007
470
F. Rivilla et al.
Figure 1 Radio-opaque shadow between the pubic bones represents the urethral stone which outlines the configuration of the female urethra (A). Retrograde cystourethrography showed a urethral stone (*) and severe deformities of the bladder neck and urethra (B).
urinary findings except a light bladder instability. Ultrasound revealed a total recovery from hydronephrosis.
Discussion Urethral calculi are infrequent and the majority are seen in male adults. Only 14 of 86 reported by Amin were in children less than 14 years of age and there were no females in the series [2]. The stones are usually secondary, and begin as vesical calculi or sometimes originate from the kidney. Calculi passing from the bladder may lodge in a diverticulum or may be due to a distal urethral stricture [2]. Primary calculus of the urethra is very rare and usually occurs in a congenital diverticulum [3,4]. A giant urethral calculus in such a young girl has, to our knowledge, not been reported previously. It seems surprising that this girl
Figure 2
presented in a relatively insidious manner. As to the aetiology, it would seem that the calculus formed primarily in the upper tracts and migrated to the urethra where it became impacted and enlarged.
Conflict of interest The authors have no conflict of interest.
Funding None.
Ethical approval Not applicable.
MRI revealed a large urethral calculus (*) extending into the bladder (A). Calculus after removal (B).
Giant urethral calculus
References [1] Maloney ME, Springhart WP, Ekeruo WO. Ethnic background has minimal impact on the etiology of nephrolithiasis. J Urol 2005; 173:2001e4.
471 [2] Amin HA. Urethral calculi. Br J Urol 1973;45:192e9. [3] Martinez A, Gonzalez C, Can ˜ada E. Giant calculus in a female urethral diverticulum. Int Urogynecol J 2000;11:45e7. [4] Sreedhar K, Singh SK, Mandal AK. Giant calculus in anterior urethral diverticulum. Urol Int 1992;48:117e9.