Ali Muhammad Wahyu, Azmi Yufi Aulia, Santoso Anugrah Dianfitriani, Soebadi Doddy Moesbadianto
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Int J Surg Case Rep. 2023 May;106:108084. doi: 10.1016/j.ijscr.2023.108084. Epub 2023 Apr 4.
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.
在本病例报告中，我们发现了一颗持续十年未导致尿潴留的巨大尿道结石，患者因非泌尿系统主诉入院。
我们报告了一名53岁患者，最初因意识减退入住急诊室。值得注意的是，患者还表现为耻骨上区膨隆。仔细检查外生殖器发现尿道口近端可触及大尺寸结石。患者亲属承认结石已存在十年，但入院前他能够自行排尿。影像学检查（腹部平片、头部CT、经腹超声）确诊为脑出血、双侧肾积水以及舟状窝结石。在全身麻醉下先后进行了脑室外引流和尿道背侧切开术，局部情况良好。我们成功从患者尿道取出4×2厘米的结石，取出结石后肾积水得到缓解。
患者因慢性尿潴留和巨大尿道结石导致的下尿路症状出现轻度肾积水。优势半球和岛叶的中风可导致急性尿潴留，从而加重肾积水。通过经尿道前尿道口取石立即引流尿液可改善患者的肾积水状况。
本报告展示了一例危重症男性患者中嵌顿性巨大尿道结石的有趣病例，该患者入院前无尿潴留。需要及时评估和处理，应优先考虑易导致患者出现严重并发症的情况。
