Giant long-standing urethral calculus without urinary retention: A case report

In this case report, we found a giant urethral stone that lasted for ten years without urinary retention and was admitted to the hospital with a non-urinary main complaint. We reported a 53-year-old patient, initially admitted to the emergency room because of decreased consciousness. Notably, the patient also presented with a bulged suprapubic area. Careful examination of the external genitalia pointed to palpable, large-sized calculus proximal to the external meatus. The patient's relatives acknowledged that the stone had been present for ten years, but he could void it spontaneously before admission. The imaging series (KUB X-Ray, Head CT, TAUS) confirmed the diagnoses of brain hemorrhage, bilateral hydronephrosis, and a stone at the navicular fossa. Sequential extra-ventricular drainage and dorsal meatotomy were performed under general anesthesia, resulting in a good local condition. We successfully extracted 4 × 2 cm calculous from the patient's urethra, and the hydronephrosis resolved after the extraction. The patient has mild hydronephrosis due to chronic urinary retention and LUTS from the giant urethral stone. The stroke to the dominant hemisphere and insula could lead to acute urinary retention, which worsens hydronephrosis. Immediate diversion of urine by taking stones from the anterior meatus urethra can improve the patient's hydronephrosis condition. This report demonstrated an interesting case of an impacted giant urethral stone in a critically ill male patient without urinary retention before admission. Prompt evaluation and management are required and should prioritize conditions predisposing patients to severe complications.