Abstract

Introduction: Most of the stones are located in the upper urinary system and urinary calculi are rarely

1%) seen in the urethra. Urethral stones are encountered infraquently in urological practice and the studies

published in the literature consist of small series and several case reports. Herein, we present 17 patients with

uretral stones.

Materials and Methods: Between January 1994 and February 2005 a total of 17 patients with urethral

calculi were enrolled into the study. The evaluation covered age, detail history, symptoms, direct urinary

system graphy, urinary ultrasonography, urinalysis, urine culture, biochemical and hematologic analysis. Also

cystouretroscopy was performed if needed. A retrograde urethrogram was performed if associated urethral

pathology was suspected. Physical examination included palpation of the urethra and rectal examination. For

anterior urethral calculi 2% lidocaine jelly was instilled in the urethra under aseptic techniques to alleviation

of spasm of the external urethral sphincter and urethral musculature, and lubrication of the urethral surface

as described in the literature. Urethral calculi were analyzed with regard to symptoms anatomical sites,

associated diseases and management.

Results: The mean age and mean follow up period of the patients was 37.2 years (range 11-68 year) and 27

months (range 4-33), respectively. In 15 (88.2%) patients urethral stones were detected by direct urinary

system graphy. In the remaining 2 (11.8%) patients, urethral stones were detected with the help of

urethroscopy. Location of the urethral calculi was fossa navicularis in 5 (35.4%) patients, posterior urethra in

4 (23.5%) patients and the other part of the anterior urethra in 8 (47.1%) patients. Associated urethral

stricture was found in 2 patients. These two patients treated with open surgery. Ventral meatotomy was

performed in 3 cases in whom the stones were lying in the fossa navicularis. Eight patients had urinary calculi

located in the other pats of the urinary system at the time of presentation (vesical 4, ureteral and renal 4).

Furthermore, 6 men with anterior urethral calculi were treated by intraurethral instillation of 2% lidocaine

jelly. Stones were milked through external meatus after a lidocain gel application in these 6 patients. Four

patients presented with acute retention of urine, while others presented with the complaints of dysuria,

burning micturation, poor stream, urinary tract infection, and penil or perineal pain. Posterior urethral

calculi were maniplated endoscopically into the urinary bladder. Four patients needed transient suprapubic

cystostomy and mechanical lithotripsy was performed in 4 cases after the stones were pushed back into the

bladder and then removed. All stones were solitary. Urinary tract infection was detected in 13 cases:

Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae. Six patients gave a past history of passing

urinary stones and two patients had ESWL of upper urinary stones.

Conclusion: Management of urethral calculi varied according to localization, size and associated urethral

pathology. Retrograde manipulation into the urinary bladder and then to perform litholopaxy or lithotripsy is

suitable procedure for posterior urethral calculi. Furthermore, anterior urethral calculi can be treated with

instillation of 2% lidocaine jelly or ventral meatotomy according to their localization. Also, bigger stones

should be treated with open surgery. Besides, if the urethra has an associated stricture or has been damaged

by prior attempts at extraction urethroplasty and stone removal are preferable.