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Multiple Urethral Calculi: Report of Case
MULTIPLE URETHRAL CALCULI REPORT OF CASE J. W. BOGER
Sedalia, Missouri Received for publication January 11, 1926
The paucity of case reports in the literature and the recent report of a case of single urethral calculus (1) leads me to believe that a report of this case would be of interest to the profession. The patient, a married man of thirty-six, consulted me on June 2, 1925, because of extreme difficulty of urination, pain and burning of approximately one year's duration. He was a structural steel worker up to five years ago when he fell astride of a steel girder and ruptured his urethra. He was taken to a hospital in St. Louis where a supra pubic cystotomy was done and numerous punctures made in the scrotum and perineum to drain out the extravistated urine. The suprapubic opening closed in about six weeks but each puncture wound remained open, through which practically all of his urine drained. About six months from the time he left the hospital it was necessary for him to return because of his inability to empty his bladder. He was given an anesthetic and a large sound forced through into the bladder. This was done about every six months until about one year ago when he refused any further treatment. For the past six months he has been scarcely able to pass his urine at all, and is unable to rest day or night because of the fearful strangury. He had recently gone through an acute attack of right sided pyelitis, and has lost 30 pounds in weight in the past year. He appeared acutely ill and was unable to stand in an upright position; walked with the aid of a cane with his legs far apart. His temperature was 102.5°F., pulse 92; respiration 32; tongue coated, and breath very foul. Physical examination was essentially negative except the scrotum which was swollen to about the size of the two fists. There were four discharging sinuses of the scrotum; one on the tip of the scro229
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J . W . BOGER
tum, one on either side near the thighs and one at the peno-scrotal junction. All the others had healed. There was a constant oozing of urine from these sinuses but no urine ever passes from the meatus. The bladder appeared empty. I was unable to get a whalebone filiform past the sinus at the penoscrotal junction and a metal olivary bougie gave a distinct click . An irregular stone about the size of a pea was then removed through an endoscopic tube. Another and larger stone was felt further down which could not be removed. On June 22, 1925, he was taken to the hospital and under ether anesthesia the urethra was opened at the peno-scrotal junction and twentyone other stones removed varying in size from a grain of wheat to one ½inch in diameter and 1 inch long. Each stone is faceted forming a continuous chain from the point of entry back to the neck of the bladder,
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4
EIGHTEEN OF TWENTY-TWO STONES REMOVED
About one-half normal size
from which point the conical one in the accompanying photo was removed. A 24 F. soft rubber catheter was inserted through the meatus and into the bladder and the urethrotomy opening closed. The catheter was left in place for four days at which time he was able to void through the normal channel. The incision healed by first intention and the other fistulous tracts were healed in about eighty days. Two weeks from the date of operation I began passing small sounds and am now able to pass a 28 F . sound into the bladder without difficulty. He has gained 43 pounds in weight, the urine is free of pus, he does not get up at night to urinate, passes a normal stream without pain, and says that in every way he feels as well as he ever did. REFERENCE
(1)
RATHBURN, N.
P . : Jour . Urol., July, 1925.
Sedalia, Missouri Received for publication January 11, 1926
The paucity of case reports in the literature and the recent report of a case of single urethral calculus (1) leads me to believe that a report of this case would be of interest to the profession. The patient, a married man of thirty-six, consulted me on June 2, 1925, because of extreme difficulty of urination, pain and burning of approximately one year's duration. He was a structural steel worker up to five years ago when he fell astride of a steel girder and ruptured his urethra. He was taken to a hospital in St. Louis where a supra pubic cystotomy was done and numerous punctures made in the scrotum and perineum to drain out the extravistated urine. The suprapubic opening closed in about six weeks but each puncture wound remained open, through which practically all of his urine drained. About six months from the time he left the hospital it was necessary for him to return because of his inability to empty his bladder. He was given an anesthetic and a large sound forced through into the bladder. This was done about every six months until about one year ago when he refused any further treatment. For the past six months he has been scarcely able to pass his urine at all, and is unable to rest day or night because of the fearful strangury. He had recently gone through an acute attack of right sided pyelitis, and has lost 30 pounds in weight in the past year. He appeared acutely ill and was unable to stand in an upright position; walked with the aid of a cane with his legs far apart. His temperature was 102.5°F., pulse 92; respiration 32; tongue coated, and breath very foul. Physical examination was essentially negative except the scrotum which was swollen to about the size of the two fists. There were four discharging sinuses of the scrotum; one on the tip of the scro229
230
J . W . BOGER
tum, one on either side near the thighs and one at the peno-scrotal junction. All the others had healed. There was a constant oozing of urine from these sinuses but no urine ever passes from the meatus. The bladder appeared empty. I was unable to get a whalebone filiform past the sinus at the penoscrotal junction and a metal olivary bougie gave a distinct click . An irregular stone about the size of a pea was then removed through an endoscopic tube. Another and larger stone was felt further down which could not be removed. On June 22, 1925, he was taken to the hospital and under ether anesthesia the urethra was opened at the peno-scrotal junction and twentyone other stones removed varying in size from a grain of wheat to one ½inch in diameter and 1 inch long. Each stone is faceted forming a continuous chain from the point of entry back to the neck of the bladder,
•
4
EIGHTEEN OF TWENTY-TWO STONES REMOVED
About one-half normal size
from which point the conical one in the accompanying photo was removed. A 24 F. soft rubber catheter was inserted through the meatus and into the bladder and the urethrotomy opening closed. The catheter was left in place for four days at which time he was able to void through the normal channel. The incision healed by first intention and the other fistulous tracts were healed in about eighty days. Two weeks from the date of operation I began passing small sounds and am now able to pass a 28 F . sound into the bladder without difficulty. He has gained 43 pounds in weight, the urine is free of pus, he does not get up at night to urinate, passes a normal stream without pain, and says that in every way he feels as well as he ever did. REFERENCE
(1)
RATHBURN, N.
P . : Jour . Urol., July, 1925.