Urethral Calculi: Presentation, Evaluation and Management

Introduction: Urethral calculi constitutes about 1-2% of all calculi in developing countries. Such calculi are more common in males in comparison to females owing to their longer urethra. Herein, we present a series of 264 such calculi.

Material and methods: This is a retrospective study of 264 cases of urethral calculi from July 2013 and February 2019. Detailed history, physical and local examination (palpation of penile urethra and perineum including Digital rectal /Per Vaginal examination) was done. Investigations included urine analysis, culture and sensitivity, ultrasonography (USG) whole abdomen with the perineal region and X-ray pelvis. A retrograde urethrogram was performed if associated urethral pathology was suspected. Cystourethroscopy confirmed the diagnosis in all cases. Patients were analysed about their age, sex, presentation, anatomical site of stone at the time of presentation, and their subsequent management. Composition of urethral calculi was studied using Fourier transform infrared spectroscopy (FTIR).

Results: A total of 264 patients with urethral calculi were analysed (250 males and 14 female). Most common age group was 21-40 years (46.8%). 203 (81.2%) of the calculi in the male patients were in the posterior urethra, 25 (10%) were in the penile/ bulbar urethra and 22(8.8%) in the fossa navicularis. The most common presenting symptom was dribbling & dysuria (70.45%). Radiological studies (X-ray pelvis and USG) showed stone in 85% of cases; Cystourethroscopy was diagnostic and discovered the stone in 15 % of additional cases. Size of stones varied from 1.2 to 2.5 cm. Most of the patients i.e. 190 (71.96 %) were treated with pushback cystolithotripsy (CLT).

Conclusion: Most urethral calculi in patients in developing countries originate from upper tract in contrast to the previous misconception that they originate in the bladder. Management of the urethral calculi varied according to the site, size and associated urethral pathology.

Keywords: Urethral calculus; anterior urethral calculi; pushback cystolithotripsy

Abbreviations: Cystolithotripsy (CLT); Ultrasonography (USG); Fourier transform infrared spectroscopy (FTIR)