Giant prostatic urethral calculus associated with urethrocutaneous fistula

Kaplan, Mustafa; Atakan, İrfan Hüseyin; Kaya, Esat; Aktoz, Tevfik; İnci, Osman

doi:10.1111/j.1442-2042.2006.01374.x

Cited by 25 publications

(16 citation statements)

References 3 publications

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“…1 The most common presentation of an impacted urethral calculus is acute urinary retention. 4,10 The stones can also produce irritative and obstructive urinary symptoms, as well as severe pain. 1,7 The pain of posterior urethral stones is typically referred to the perineum, and patients with anterior stones may present with localized penile pain.…”

Section: Discussionmentioning

confidence: 99%

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A stone down below: a urethral stone causing acute urinary retention and renal failure

Bielawska

Epstein

2010

CJEM

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Impaction of a kidney stone in the male urethra is a rare sequela of an otherwise common disease process. Case reports of urethral stones in the recent literature are scarce. We report a case of a 48-year-old man who presented with an impacted urethral stone as a complication of nephrolithia sis. The pathology was twice missed, even with computed tomography showing the stone in the prostatic urethra, which highlights the challenges of making this diagnosis. We review the existing literature outlining the pathogenesis, clinical features and therapeutic considerations as they relate to urethral stones. We underscore the role of the emergency physician in the diagnosis and initial management of this entity, and draw attention to the need to evaluate not just the upper but also the lower genitourinary tracts when interpreting computed tomographic images obtained for the diagnosis of renal colic.Keywords: renal colic, urethral stone, computed tomographic urography RÉSUMÉUn calcul rénal enclavé dans l'urètre chez un homme est une séquelle rare d'un processus morbide généralement courant. On trouve peu de rapports de cas de calculs urétraux dans la récente littérature. Nous présentons le cas d'un homme de 48 ans qui avait un calcul urétral enclavé, comme complication d'une lithiase urinaire. À deux reprises, la pathologie n'a pas été diagnostiquée, même sur des images tomographiques montrant le calcul dans l'urètre prostatique, ce qui met en évidence la difficulté de poser ce diagnostic. Nous avons passé en revue la littérature existante décrivant la pathogenèse, les caractéristiques cliniques et les considéra-tions thérapeutiques des calculs urétraux. Nous soulignons le rôle du médecin d'urgence dans le diagnostic et la prise en charge initiale de cette entité, et attirons l'attention sur la nécessité d'examiner non seulement la partie supérieure du tractus génito-urinaire mais aussi la partie inférieure lors de l'interprétation des images tomographiques obtenues pour le diagnostic de colique néphrétique.

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Section: Discussionmentioning

confidence: 99%

“…10 The objectives of treatment are to provide analgesia, relieve the urinary obstruction and remove the stone without damaging the urethra. The level of involvement of the emergency physician will vary depending on the availability of urologic consultation.…”

Section: A B C Dmentioning

confidence: 99%

A stone down below: a urethral stone causing acute urinary retention and renal failure

Bielawska

Epstein

2010

CJEM

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“…14 Reports of urethrocutaneous fistulas are rare in the literature: one associated with treatment for painful priapism 15 and another associated with a prostatic urethral calculus. 16 …”

Section: Discussionmentioning

confidence: 99%

Urethrocutaneous fistula after use of Tegress bulking agent: Case report and review of the literature

Mukkamala

Latini²,

Cameron³

2013

CUAJ

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We report a case of a 68-year-old man who presented with a urethrocutaneous fistula after off-label use of Tegress (C. R. Bard, Inc., Murray Hill, NJ) Urethral Implant for post-prostatectomy incontinence. He was treated for prostate cancer with an open radical retropubic prostatectomy and adjuvant external beam radiation therapy. He was treated unsuccessfully for stress incontinence with a Tegress Urethral Implant and presented to our clinic initially with extrusion of the material urethrally. Four years later he re-presented with a large bullous skin lesion on his suprapubic area. Contrast-enhanced magnetic resonance imaging and retrograde urethral cystogram demonstrated a urethrocutaneous fistula. Subsequent cystoscopy revealed the calcified extruded material in the same location as the site of Tegress injection. The patient underwent simple cystectomy with ileal diversion. He recovered well postoperatively. This appears to be the first reported case of urethrocutaneous fistula after use of a Tegress Urethral Implant for post-prostatectomy stress urinary incontinence. Case reportA 68-year-old man initially presented with a 4-year history of persistent stress urinary incontinence (SUI) requiring diapers, severe perineal pain, and recurrent occasional urinary retention requiring catheterization. He had a history of prostate cancer treated in 2003 with open radical retropubic prostatectomy (RRP) and adjuvant external beam radiation therapy.He had no open surgical procedures for incontinence, but had 2 Tegress (C. R. Bard, Inc., Murray Hill, NJ) Urethral Implant injections in 2006 to treat his incontinence, which had no effect. After the injections he developed painful urination, increased frequency and urgency, blood in his urine, perineal pain and penile discharge described as "a solid substance, gravel-like." He then presented at our institution in 2007 where, on physical examination, he had significant urinary leakage from the urethral meatus and tenderness to deep palpation of the perineal area. The scrotum, testes, and epididymis were normal. Urinalysis showed +2 leukocytes, positive nitrites, trace protein, and 50 heme. Urine cytology was negative for neoplasm. Cystoscopy was performed and showed material at both the 12 (anterior) and 6 o'clock (posterior) position, with only the 6 o'clock position showing material extrusion. The patient was then followed for several years by our clinic with 9 separate cystourethroscopies to debride the extruding Tegress material from the 6 o'clock position since the anterior position was epithelialized. These were performed utilizing a resectoscope with a cold loop. He was also found to have an acquired bladder neck contracture, which was dilated during these procedures. He was started on a trial of solifenacin 10 mg to manage his urinary incontinence. The severe, chronic perineal pain was managed initially with ibuprofen 800 mg twice a day and then duloxetine 60 mg once a day when he complained of being unable to "sit for more than an hour" without significant pai...

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“…Cal cu li may form pro xi mal to uret hral stric tu res, in con ge ni tal and ac qu i red uret hral diver ti cu la, with chro nic in fec ti on, with fo re ign bodi es and with use of ha ir-be a ring skin for uret hrop lasty. [3][4][5] Na ti ve uret hral sto nes ge ne rally do not ca u se acu te symptoms be ca u se of the ir slow de ve lop ment and growth. The ma in symptoms are acu te uri nary re ten ti on, fre qu ency, dysuri a, po or or in ter rup ted uri nary stre am, in comp le te emp tying, and dribb ling or in con tinen ce.…”

Section: Discussionmentioning

confidence: 99%

“…Predisposing factors include diabetes mellitus, local trauma, paraphimosis, periurethral extravasation of urine, perirectal or perianal infections, and surgery such as circumcision or herniorrhaphy. 2 If calculi stay in an urethral diverticulum for years, it may cause recurrent urinary tract infections, urethrocutaneous fistula 3 and probably Fournier's gangrene. We herein report, to our knowledge the first case in the English literature, of a posterior urethral calculus associated with Fournier's gangrene.…”

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confidence: 99%

Giant Posterior Urethral Calculus Associated with Fournier’s Gangrene:Case Report

Sunay¹,

Dadali²,

Yalbuzdağ³

et al. 2011

Turkiye Klinikleri J Med Sci

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1019rethral calculi are uncommon and may arise primarily in an urethral diverticulum.1 Fournier's gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region. Predisposing factors include diabetes mellitus, local trauma, paraphimosis, periurethral extravasation of urine, perirectal or perianal infections, and surgery such as circumcision or herniorrhaphy.2 If calculi stay in an urethral diverticulum for years, it may cause recurrent urinary tract infections, urethrocutaneous fistula 3 and probably Fournier's gangrene. We herein report, to our knowledge the first case in the English literature, of a posterior urethral calculus associated with Fournier's gangrene.Giant Posterior Urethral Calculus Associated with Fournier's Gangrene:Case Report A AB BS S T TR RA AC CT T Uret hral cal cu li are ra re and most of them ori gi na te in the up per uri nary tract or in the blad der. A re vi ew of the li te ra tu re re ve als that less than 2% of uri nary tract sto nes are pri ma rily loca ted in the uret hra. Uret hral cal cu li are usu ally as so ci a ted with uret hral stric tu re or uret hral diver ti cu lum and may be lod ged in the uret hra du ring the ir pas sa ge. Cal cu li in the uret hral di ve ti cu lum may ca u se re cur rent uri nary tract in fec ti ons and a pos sib le Fo ur ni er's gan gre ne. Fo urni er's gan gre ne is a form of nec ro ti zing fas ci i tis af fec ting the ma le ge ni ta li a. In fec ti on most commonly ari ses from the skin, uret hra or rec tal re gi on. He re in, to our know led ge, the first ca se of an enor mo usly lar ge sto ne (4.8 x 8.9x 9.2 cm) in the pro xi mal uret hra pre sen ting with Fo ur ni er's gangre ne is re por ted.K Ke ey y W Wo or rd ds s: : Uret hral di se a ses; cal cu li; Fo ur ni er gan gre ne Ö ÖZ ZE ET T Üret ra ta şı az gö rü len bir kli nik an ti te dir ve ol gu la rın ço ğu üst üri ner trakt tan ve ya me sa neden kay nak la nır. Li te ra tü rü göz den ge çi ren bir ça lış ma üri ner trakt taş la rı nın %2'sin den da ha azı -nın pri mer ola rak üret ra da yer leş ti ği ni gös ter mek te dir. Üret ral taş has ta lar da ge nel lik le üret ral dar lık ve ya üret ral di ver ti kül ile bir lik te dir ve pa saj la rı sı ra sın da üret ra ya yer le şe bi lir ler. Üret ral di ver ti kül de ki taş lar re kü ren üri ner trakt en fek si yon la rı na ve hat ta Fo ur ni er gan gre ni ne yol aça bilir ler. Fo ur ni er gan gre ni nek ro ti zan fa si i ti sin er kek ge ni tal böl ge sin de or ta ya çı kan bir for mu dur. En fek si yon ge nel lik le de ri, üret ra ve ya rek tal böl ge den kay nak la nır. Bu ra da bi zim bi gi mi ze gö re lite ra tür de muh te me len ilk kez Fo ur ni er gan gre ni ile pre zen te olan prok si mal üret ra da ki çok bü yük, dev bir taş (4.8 x 8.9 x 9.2 cm) ol gu su su nul mak ta dır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Üret ra has ta lık la rı; taş lar; Four ni er gan gre ni T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J

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Giant prostatic urethral calculus associated with urethrocutaneous fistula

Cited by 25 publications

References 3 publications

A stone down below: a urethral stone causing acute urinary retention and renal failure

A stone down below: a urethral stone causing acute urinary retention and renal failure

Urethrocutaneous fistula after use of Tegress bulking agent: Case report and review of the literature

Giant Posterior Urethral Calculus Associated with Fournier’s Gangrene:Case Report

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