Urethral Obstruction From Dislodged Bladder Diverticulum Stones

A Case Report

Linus I Okeke; Augustine O Takure; Sikiru A Adebayo; Olukayode Y Oluyemi; Abimbola AA Oyelekan

Disclosures

BMC Urol. 2012;12(31) 

In This Article

Case Presentation

A 69 year old, male, Nigerian who was initially seen with a 4 year history of storage and voiding lower urinary tract symptoms. At that presentation, he had an episode of acute urinary retention that was relieved by urethral catheterization. Thereafter, he had a failed trial of voiding without catheter and was advised to change his catheter at 3 weekly intervals while on α-adrenergic receptor blocker. The digital rectal examination revealed benign prostate enlargement.

The abdomino-pelvic ultrasound showed a 64gm prostate and a posterior bladder diverticulum that measured 8x8x7cm3. The serum prostate specific antigen was 7.5ng/dl and prostate biopsy was reported as nodular hyperplasia and chronic prostatitis while the serum electrolytes, urea and creatinine were normal. He was treated for chronic prostatitis and continued to take the α-adrenergic receptor blocker. He was lost to follow up for 4 years during which time he had a TURP elsewhere and remained symptom free.

He presented to us with retained urethral catheter that was passed 4months prior to seeing us for acute urinary retention. After removal of his urethral catheter, it was impossible to pass another one therefore a suprapubic cystostomy was performed. Urodynamic studies were not done.

Four weeks after the suprapubic cystostomy, he presented with severe urethral pain and examination revealed impacted urethral stone at the tip of his external urethral meatus and completely granular anterior urethra. Plain radiograph of the penis and lower abdomen showed radio-opaque shadows in the bladder, bladder diverticulum, posterior and anterior urethra (Figure 1). The clinical diagnosis was urethral obstruction from dislodged bladder diverticulum stones.

Figure 1.

Plain radiograph showing diverticulum, bladder neck, and urethral stones (arrow).

Under caudal anaesthesia (2% plain xylocaine solution) and sedation with intramuscular pentazocine 30mg, we attempted to push the stones endoscopically into the bladder but this failed. Thereafter, he had meatotomy with 2% xylocaine jelly being instilled into the urethra. After waiting for 10 minutes, he had antegrade manual stone extraction with sinus forceps and intermittent lubrication of the urethral with 2% xylocaine jelly (Figure 2). All the stones were completely removed and a check Cystoscopy confirmed the wide neck urethral Diverticulum (Figure 3).

Figure 2.

Manual antegrade removal of urethra stones.

Figure 3.

bladder mucosa bridge separating bladder cavity (arrow up) and posterior bladder diverticulum below (arrow down).

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