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Urethral Steinstrasse Causing Acute Urinary Retention
Images in Clinical Urology Urethral Steinstrasse Causing Acute Urinary Retention Surya Prakash Vaddi, Rahul Devraj, Vedamurthy Reddy, Ajit Vikram, Sreedhar Dayapule, and Ragavan Munisami Multiple urethral calculi–forming steinstrasse in the urethra leading to acute urinary retention is a rare event in pediatric urolithiasis. We report a child with urethral steinstrasse that cleared spontaneously with attempted urethral catheterization UROLOGY 77: 594 –595, 2011. © 2011 Elsevier Inc.
Figure 1. X-KUB showing multiple right renal calculi and multiple linearly placed calculi along the urethra (urethral steinstrasse).
CASE REPORT
A
10-year-old boy presented to the emergency department with lower abdominal pain and acute urinary retention. Previously he had passed stones in urine. On examination he was afebrile with
From the Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India Reprint requests: Surya Prakash Vaddi, M.S., FRcsed, M.CH, DNB, Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore524 002, Nellore, Andhra Pradesh, India. E-mail: [email protected] Submitted: Feb 28, 2010, accepted (with revisions): April 5, 2010
594
© 2011 Elsevier Inc. All Rights Reserved
Figure 2. Postoperative X-KUB after right PCNL, showing complete stone clearance.
normal vital signs. Abdomen revealed a grossly distended bladder. External genitalia showed normal meatus, and multiple stones were felt all along the ventral aspect of urethra. Catheterization with an infant feeding tube failed, and a suprapubic cystostomy was performed. Ultrasound of the abdomen showed multiple right renal calculi. Kidney ureter bladder x-ray showed multiple right renal calculi and linearly placed calculi along the urethra. The X-ray appearance resembled steinstrasse in the urethra (Fig 1). The patient passed all of the urethral calculi spontaneously 1 day after the suprapubic cystostomy. Attempted urethral catheterization might have 0090-4295/11/$36.00 doi:10.1016/j.urology.2010.04.003
dislodged the impacted lead stone, and thus led to spontaneous passage of all calculi. This child later underwent right percutaneous nephrolithtotomy (Fig 2).
CONCLUSIONS De novo urethral steinstrasse in a child, causing acute urinary retention, is rare and to our knowledge is not reported in the literature.
COMMENT Urethral steinstrasse after extracorporeal shock wave lithotripsy is reported in literature.1 Brahmbhatt et al reported urethral steinstrasse following cystolithotripsy in a transplant recipient.2 Urethral steinstrasse can be cleared by endoscopic extraction of the calculi or by in situ lithotripsy.
UROLOGY 77 (3), 2011
References 1. Bhat HS, Ramgopal KS, Philipraj J. Urethral steinstrasse: an unusual complication of ESWL. Indian J Urol. 1997;14:52. 2. Brahmbhatt YG, Schlesinger DA, Wadhwa NK. Urethral steinstrasse in renal transplantation. Kidney Int. 2009;75:344.
595
Figure 1. X-KUB showing multiple right renal calculi and multiple linearly placed calculi along the urethra (urethral steinstrasse).
CASE REPORT
A
10-year-old boy presented to the emergency department with lower abdominal pain and acute urinary retention. Previously he had passed stones in urine. On examination he was afebrile with
From the Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India Reprint requests: Surya Prakash Vaddi, M.S., FRcsed, M.CH, DNB, Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore524 002, Nellore, Andhra Pradesh, India. E-mail: [email protected] Submitted: Feb 28, 2010, accepted (with revisions): April 5, 2010
594
© 2011 Elsevier Inc. All Rights Reserved
Figure 2. Postoperative X-KUB after right PCNL, showing complete stone clearance.
normal vital signs. Abdomen revealed a grossly distended bladder. External genitalia showed normal meatus, and multiple stones were felt all along the ventral aspect of urethra. Catheterization with an infant feeding tube failed, and a suprapubic cystostomy was performed. Ultrasound of the abdomen showed multiple right renal calculi. Kidney ureter bladder x-ray showed multiple right renal calculi and linearly placed calculi along the urethra. The X-ray appearance resembled steinstrasse in the urethra (Fig 1). The patient passed all of the urethral calculi spontaneously 1 day after the suprapubic cystostomy. Attempted urethral catheterization might have 0090-4295/11/$36.00 doi:10.1016/j.urology.2010.04.003
dislodged the impacted lead stone, and thus led to spontaneous passage of all calculi. This child later underwent right percutaneous nephrolithtotomy (Fig 2).
CONCLUSIONS De novo urethral steinstrasse in a child, causing acute urinary retention, is rare and to our knowledge is not reported in the literature.
COMMENT Urethral steinstrasse after extracorporeal shock wave lithotripsy is reported in literature.1 Brahmbhatt et al reported urethral steinstrasse following cystolithotripsy in a transplant recipient.2 Urethral steinstrasse can be cleared by endoscopic extraction of the calculi or by in situ lithotripsy.
UROLOGY 77 (3), 2011
References 1. Bhat HS, Ramgopal KS, Philipraj J. Urethral steinstrasse: an unusual complication of ESWL. Indian J Urol. 1997;14:52. 2. Brahmbhatt YG, Schlesinger DA, Wadhwa NK. Urethral steinstrasse in renal transplantation. Kidney Int. 2009;75:344.
595