Archives of Urology and Renal Diseases Case Report Open Access | Research Large Primary Calculus in Female Urethral Diverticulum Abhay Dinkarrao Mahajan*, Sumeeta Abhay Mahajan Department of Urology, Sai Urology Hospital, India Abstract Female urethral diverticulum is a common condition but stones in diverticulum are rarely seen. We present two such interesting cases of large stone in female urethral diverticulum. Lower Urinary tract symptoms in females should be carefully evaluated and uncommon clinical conditions should be considered and evaluated for accurate diagnosis and treatment. Keywords: Calculus, Female, Urethra, Diverticulum Introduction of symptoms. Incidence of female urethral diverticulum is not a rare condition, but formation of stone in the diverticulum is an uncommon com- plication. The prevalence of urethral diverticulum in females is between 0.6% to 6% [1]. Incidence of stones in urethral diverticu- lum is around 4% to 10% of cases [2,3]. Most of the women are as- ymptomatic & usually present with complications like infection, stones or tumours. We present two cases of large calculus in fe- male urethral diverticulum. Case report Case1: A 45-year-old female presented with dysuria and urinary tract infection. Ultrasonography & X ray KUB showed a calculus at the bladder neck. On these findings the patient was explored for cystolithotomy by a Surgeon& bladder was closed as no stone was found in the bladder. The symptoms persisted & the patient was further referred to Urologist. On PV examination a hard mass was felt in the anterior vaginal wall. Ultrasonography and XR KUB suggested a large 2 cms calculus in the urethra [Figure 1]. As- Figure 1: KUB showing a large Calculus Overlapping the Pubic Sym- cending urethrogram showed that the calculus was in the female physis. urethral diverticulum [Figure 2]. Surgical excision of the diver- ticulum & extraction of the calculus was performed through the anterior vaginal wall approach. Patient’s symptoms improved sig- nificantly. Patient was followed up for one year with no recurrence Citation: Mahajan AD, Mahajan SA (2020) Large Primary Calculus in Female Urethral Diverticulum. Arch Uro Ren Dis 3(1): 1-3. Received Date: 18 March 2020; Accepted Date: 23 March 2020; Published Date: 01 April 2020 *Corresponding Author: Abhay Dinkarrao Mahajan, Department of Urology, Sai Urology Hospital, I Aurangabad, Maharashtra, Pin: 431005, India. Tel: +91 9822321224; E-mail: drabhaymahajan@ gmail.com. Copyright: © Mahajan AD, Open Access 2020. This article, published in Arch Uro Ren Dis (AURD) (Attribution 4.0 International), as described by http:// creativecommons.org/licenses/by/4.0/. Figure 2: Micturating Cystourethrogram Showing Stone in The Ure- Arch Uro Ren Dis (AURD) 2020 | Volume 3 | Issue 1 1 Large Primary Calculus in Female Urethral Diverticulum thral Diverticulum. Case 2: A 50-year-old female presented with a mass in the introi- tus. On local examination there was large visible swelling in the anterior vaginal mass [Figure 3] It was hard on palpation. KUB & MCU confirmed the diagnosis of a large calculus in the female urethral diverticulum. Excision of the diverticulum & extraction of the calculus was done [Fig 4& Figure 5]. The diverticulum was large of the size 2.5 cms X3 cms. As the defect was big in the ure- thra, after primary closure of the urethra with 3-0 vicryl, a Martius labial fat pad was placed to prevent urethrovaginal fistula. Anteri- or vaginal wall was closed over the Martius flap. Figure 5: Excised Diverticulum with Stone. Discussion Urethral diverticulum is commonly found in females but presence of stones in the diverticulum is a rare condition. The clinical trial of dysuria, dyspareunia & post micturition dribble is not always seen in patients suffering from urethral diverticulum and hence they go undetected. Aurethral diverticulum should be suspected when the patient is not responding to treatment and has recurrent urinary tract infection. Patients having stone in the diverticulum usually presents with mass effect, incontinence, pain and urinary tract infection [4]. The stone formation is usually because of stasis of urine and urinary infection in the diverticulum [5]. Presence of hard mass in the floor of urethra is the most important diagnos- tic indication of calculus in the female urethral diverticulum [6]. Cystourethrography usually confirms the diagnosis of calculus in the diverticulum but can be missed if the contrast doesn’t fill the Figure 3: Large swelling in the introitus. diverticulum adequately [7]. A double balloon catheter study is also suggested for diagnosis of female urethral diverticulum [8]. Surgi- cal excision is the best modality of treatment. On positive clinical finding of hard mass in the anterior vagi- nal wall, calculus was suspected & an ascending urethrogram was performed which clinched the diagnosis. The diverticulum was excised & stone was extracted which gave complete relief to the patient. Hence, we suggest that all female lower urinary tract symptoms should be carefully evaluated for diagnosis of rare clinical conditions. References 1. Beatrice J, Strebel RT (2008) Giant Calculi in Urethral Diver- ticula. CMAJ 178(8): 994. 2. Romanzi LJ, Groutz A, Blaivas JG (2000) Urethral Divertic- ulum in Women: Diverse Presentations Resulting In Diagnostic Delay & Mismanagement. J Urol 164: 426-33. 3. Ward JN, Draper JW, Tovell HM (1967) Diagnosis and Treat- Figure 4: Large diverticulum incised & opened. ment of Urethral Diverticulum in The Female. Surg Gyneol Ob- stet 125: 1293-1300. 4. Shim JS1, Oh MM, Kang JI, Ahn ST, Moon du G, et al. (2011) Arch Uro Ren Dis (AURD) 2020 | Volume 3 | Issue 1 2 Large Primary Calculus in Female Urethral Diverticulum Calculi in a Female Urethral Diverticulum. Int neurourol J 15(1): 55-57 5. Ginsberg P, Finkelstein U (1983) Urethral diverticulum with calculi : report of a case. J Am Osteopath Assoc 82: 588-590. 6. Pressman D, Polnick D, Zumercheck J (1964) Calculus Forma- tion Within a Diverticulum of Female Urethra. J Urol 91: 376-379. 7. Larkin GL, Weber JF (1996) Giant Urethral Calculus: A Rare Cause of Acute Urinary Retention. J Emerg Med 14: 707-709. 8. Greenberg M, Stone D, Cochran ST, Bruskewitz R, JJ Pagani, et al. (1981) Female Urethral Diverticula: Double- Balloon Cath- eter Study. AJR 136: 259-264. Arch Uro Ren Dis (AURD) 2020 | Volume 3 | Issue 1 3.