Management of urethral diverticular stone with stricture: a case report

Abstract Background Acquired male urethral diverticula are seen in patients with traumatic urethral stricture, urethral surgery, or rarely following prolonged urethral catheterization. Inadequate drainage of the urethral diverticulum leads to urinary stasis and stone formation. Excision of the urethral diverticulum with reconstruction of the urethral defect is the definitive procedure. A limited number of cases were reported in the literature. Case presentation Excision of the urethral diverticulum with reconstruction of the urethral defect is the definitive procedure. Large urethral diverticulum with stone following urethral surgery with adjacent stricture is challenging to manage. We report a case of a urethral diverticular stone with stricture in a 58-year-old male treated successfully using an excessive diverticular wall as a flap to reconstruct the adjacent stricture after removing the stone. We performed a retrograde urethrogram (RGU) and obtained information about the caliber of the urethra and the location of the diverticulum. The objectives in the treatment of symptomatic urethral diverticula are relief of distal obstruction, removal of all calculi, excision of the diverticulum, and closure of the urethral defect. Management options for this case are excision of the diverticulum with urethral reconstruction, optical urethrotomy and lithotripsy, perineal urethrostomy with stone extraction, and two-stage operations to remove the stone followed by urethral reconstruction. Conclusions Even though the recommended management for acquired male UD is diverticulectomy with the reconstruction of the urethra, in selected cases, less morbid procedures like urethral reconstruction with excess diverticular wall without diverticulectomy can be done to maintain urethral patency.