Management of Impacted Urethral Calculi: An Uncommon Cause of Acute Urine Retention in North-western Nigeria

Urethral stones though rare manifestation of urolithiasis may be primary but mostly are secondary arising from either the urinary bladder or the upper tract. When impacted in the urethra may result in acute urinary retention and difficulty in urethral catheterization. Various treatment modalities are available ranging from initial suprapubic cystostomy and subsequent open surgical or endoscopic procedures as well as treatment of associated urethral pathology. We report our experience in the management of patients with acute urine retention due to impacted urethral calculi in a tertiary hospital. This was a retrospective review of forty patients with impacted urethral stones managed at the Urology Unit, Department of Surgery Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2005 to December 2015. Data were collected from patients’ case notes and entered in to a proforma and analysed using SPSS 20.0 version for Windows. Forty patients comprising of one female (2.5%) and 39 males (97.5%), mean age was 25±17.4 years with a range of 1-63yrs. In twenty patients (50%), attempt at urethral catheterization was not successful. Location of the impacted calculi were meatal 7 (17.5%), distal penile 4 (10%), mid penile 8 (20%), proximal penile 1 (2.5%), bulbar 4 (10%), peno-bulbar junction 3 (7.5%), posterior urethra 11 (27.5%), and bladder neck 2 (5%). Spontaneous extrusion of the calculi occurred in 4 (10%), while expulsion occurred in 2 (5%) after intra-urethral instillation of 2% lidocaine jelly. Other treatment modalities in the remaining patients included; meatotomy 11 (27.5%), open urethrolithotomy 6 (15%), urethroscopy and pneumatic lithotripsy 6 (15%), urethroscopy and stone retrieval 1 (2.5%), urethrolithotomy and urethroplasty 2 (5%), and cystolithotomy 8 (20%). Impacted urethral stone may be a cause of acute urinary retention and failed urethral catheterisation. The stone can pass spontaneously with or without manipulation or can be removed by endoscopic or open technique when spontaneous passage is not successful.