Calculosis in a male urethral pseudodiverticula

Clinical History

A case of urinary incontinence after transurethral prostatectomy, with dysuria and lack of force of the urinary stream.

Imaging Findings

The patient attended the urology out-patient clinic because of total urinary incontinence. In 1973 he had undergone transurethral prostatectomy as a result of benign prosthatic hypertrophy. In 1981 an artificial urethral sphincter was implanted using the Scott-Bradley-Timm method. However, in the follow-up the urethral cuff became infected and the artificial sphincter was removed in 1995. Since then the patient has used a uridom with a penis clamp. Prior to presentation the patient had experienced painful voiding and reduced stream. Furthermore, post-operatively the patient had developed a ventral hernia.

Blood samples indicated no actual infection and normal renal function. An overview of the bladder (Fig. 1) followed by a retrograde urethrogram (Fig. 2) showed calculi placed in a diverticula-like form in the prostatic part of the urethra (pseudodiverticula), where the artificial sphincter (the clamp) had been previously implanted. A small urethrocele can also be seen on the lateral projection of the retrograde urethrogramm. There was no urethral stricture. Surgical removal was subsequently offered.

Discussion

Calculi that form within the urethra are described as native calculi. Most are associated with urethral abnormalities that lead to stasis and infection, particularly urethral strictures and diverticula. Urethral diverticula may be congenital, but most are secondary to infection in the paraurethral glands in males and females or, as in this case, are caused by urethroplasty of the urinary tract, in our case - calculi in a urethral pseudodiverticula combined with urethrocele. This is a rare post-operative complication after insertion of a urethral prosthesis. Other types of complication are urethral erosion and mechanical malfunctioning(1,2,3).

The gold standard imaging technique for the diagnosis of urethral calculi is retrograde urethrography, which detects and localises the urethral calculi and associated abnormalities such as strictures and/or diverticula/pseudodiverticula-like formations(1). MR urography may be an alternative method of choise for visualisation of these pathologies but often giving signal-poor elements(4,5). Ultrasonography and/or transperineal sonography are useful as supplementory diagnostic options, but conventional urethrography, as gold standard in urologic pre-operative planning, is preferable.

Differential Diagnosis List

Final Diagnosis

Urethral calculi combined with pseudodiverticula

URL:	https://www.eurorad.org/case/1399
DOI:	10.1594/EURORAD/CASE.1399
ISSN:	1563-4086