Vol. 115, June Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
GIANT URETHRAL CALCULUS: A CASE REPORT RAJA MUSTAFA HASSAN From the Department of Surgery, Mosul University College of Medicine, Mosul, Iraq
ABSTRACT
A case of a large urethral calculus in a woman with the unusual symptom 9f dyspareunia is presented. The patient had to manipulate a prolapse-like bulging of the anterior vaginal wall to ease micturition. The radiological appearance is interesting. CASE REPORT
A 30-year-old village housewife, Para 7, was admitted to the hospital on July 15, 1974, complaining of acute retention of urine. She was catheterized with difficulty and an x-ray was requested. History included lower abdominal pain, frequency and dysuria since the age of 7 years. The patient was married in 1958 and the symptoms became more pronounced. Dyspareunia, burning micturition, urgency, dribbling of urine and itching in the vulva developed 3 years before hospitalization.
anterior prolapse of the uterus. The bulging was hard and tender. A click was heard on passing a metal catheter and a grating sensation was experienced. Investigations included urinalysis with pyuria and a few red blood cells, blood urea 46 mg. per 100 ml., hemoglobin 75 per cent, normal chest x-ray, early pyelectasis of the right kidney on excretory urography (IVP) and normal left kidney, ureters and bladder. A large, rather spindle-shaped calculus occupied nearly the entire urethra (part A of figure). With the patient under general anesthesia the stone was reached by a finger through the external meatus but could not
A, IVP shows bladder and urethra with stone in urethra. B, photograph shows bulging of anterior vaginal wall produced by stone. Tip of artery forceps is in urethral orifice. C, photograph of stone.
The patient discovered that urination was made easier by pushing a swelling that was protruding from the vagina. A few months ago she suffered bouts of fever, pyuria and increasing pain and tenderness in the suprapubic region. Examination revealed an emaciated and pale woman. The liver and spleen were enlarged, and the kidneys were not palpable. Locally the external urinary meatus was patulous. There was bulging of the anterior vaginal wall resembling Accepted for publication November 26, 1975.
be delivered manually through the vagina (part B of figure). Meatotomy was done and the stone was extracted (part C of figure). It was a dirty white, smooth phosphate stone, 5 cm. long and 3.2 cm. wide. Convalescence was uneventful. COMMENT
Urethral calculi are rare among female subjects. All 86 cases of urethral calculi reported on by Hussein were in male subjects. 1 Manipulating a swelling produced by a urethral stone to ease urination has been described by Vanderhorst in a
756
757
GIANT URETHRAL CALCULUS
male patient with a giant urethral calculus. 2 This procedure appears to partially dislodge the stone that acts as a ball valve. To my knowledge dyspareunia has not been reported previously as a symptom of urethral calculus. As a shy village housewife the patient did not express this complaint until she was forced to by retention. This fact explains the long history and the large size of the stone. It is not within the scope of this paper to discuss why the stone did not pass despite no distal
obstruction. The large size of the stone situated low in the urethra was responsible for the prolapse-like appearance of the anterior vaginal wall. REFERENCES
1. Hussein, A. A.: Urethral calculi. Brit. J. Urol., 45: 192, 1973. 2. Vanderhorst, L. F. Von P.: Giant urethral calculus: a case report. J. Urol., 80: 31, 1958.
THE JOURNAL OF UROLOGY
Copyright © 1976 by The Williams & Wilkins Co.
GIANT URETHRAL CALCULUS: A CASE REPORT RAJA MUSTAFA HASSAN From the Department of Surgery, Mosul University College of Medicine, Mosul, Iraq
ABSTRACT
A case of a large urethral calculus in a woman with the unusual symptom 9f dyspareunia is presented. The patient had to manipulate a prolapse-like bulging of the anterior vaginal wall to ease micturition. The radiological appearance is interesting. CASE REPORT
A 30-year-old village housewife, Para 7, was admitted to the hospital on July 15, 1974, complaining of acute retention of urine. She was catheterized with difficulty and an x-ray was requested. History included lower abdominal pain, frequency and dysuria since the age of 7 years. The patient was married in 1958 and the symptoms became more pronounced. Dyspareunia, burning micturition, urgency, dribbling of urine and itching in the vulva developed 3 years before hospitalization.
anterior prolapse of the uterus. The bulging was hard and tender. A click was heard on passing a metal catheter and a grating sensation was experienced. Investigations included urinalysis with pyuria and a few red blood cells, blood urea 46 mg. per 100 ml., hemoglobin 75 per cent, normal chest x-ray, early pyelectasis of the right kidney on excretory urography (IVP) and normal left kidney, ureters and bladder. A large, rather spindle-shaped calculus occupied nearly the entire urethra (part A of figure). With the patient under general anesthesia the stone was reached by a finger through the external meatus but could not
A, IVP shows bladder and urethra with stone in urethra. B, photograph shows bulging of anterior vaginal wall produced by stone. Tip of artery forceps is in urethral orifice. C, photograph of stone.
The patient discovered that urination was made easier by pushing a swelling that was protruding from the vagina. A few months ago she suffered bouts of fever, pyuria and increasing pain and tenderness in the suprapubic region. Examination revealed an emaciated and pale woman. The liver and spleen were enlarged, and the kidneys were not palpable. Locally the external urinary meatus was patulous. There was bulging of the anterior vaginal wall resembling Accepted for publication November 26, 1975.
be delivered manually through the vagina (part B of figure). Meatotomy was done and the stone was extracted (part C of figure). It was a dirty white, smooth phosphate stone, 5 cm. long and 3.2 cm. wide. Convalescence was uneventful. COMMENT
Urethral calculi are rare among female subjects. All 86 cases of urethral calculi reported on by Hussein were in male subjects. 1 Manipulating a swelling produced by a urethral stone to ease urination has been described by Vanderhorst in a
756
757
GIANT URETHRAL CALCULUS
male patient with a giant urethral calculus. 2 This procedure appears to partially dislodge the stone that acts as a ball valve. To my knowledge dyspareunia has not been reported previously as a symptom of urethral calculus. As a shy village housewife the patient did not express this complaint until she was forced to by retention. This fact explains the long history and the large size of the stone. It is not within the scope of this paper to discuss why the stone did not pass despite no distal
obstruction. The large size of the stone situated low in the urethra was responsible for the prolapse-like appearance of the anterior vaginal wall. REFERENCES
1. Hussein, A. A.: Urethral calculi. Brit. J. Urol., 45: 192, 1973. 2. Vanderhorst, L. F. Von P.: Giant urethral calculus: a case report. J. Urol., 80: 31, 1958.
