Hazem Amer, Mohamed E. Abbasy, Mai M. Ahmed, Ahmed Hamdi Ebrahim and Stephen H. Thomas
Emergency Department, Hamad General Hospital, Qatar
Posters & Accepted Abstracts: Primary Health Care
Background: Urethral stones are a rare occurrence in the industrialized world, accounting for 0.3%2% of all urinary tract stones. To cause obstruction, the stones generally have to be larger than 1 cm in diameter, open surgical and endoscopic intervention are the mainstay of treatment. We are presenting a rare case of large anterrior urethral stone impaction with subsequent non operative management. Presentation: 28 years old male presented to emergency department with acute urine retention for 2 hours with history of occasional right flank pain for the past 2 days. Physical examination revealed suprapubic enlarged urinary bladder, suprapubic tenderness and partially seen large anterior urethral stone 1 cm proximal to penile meatus. Bedside US showed enlarged urinary bladder with bilateral mild hydro nephrosis. After giving patient proper analgesia, treatment options were discussed including stone pushing back into the bladder for subsequent lithotripsy, in situ lithotripsy and open surgery but patient refused these options. A trial of facilitating manual expulsion with instillation of 2% lidocaine jelly was tried but was unsuccessful. Finally, after 2% lidocaine instillation was performed, a trial of judicious successful crushing the stone into 2 large pieces with forceps extraction of other small fragments was performed in less than 3 minutes. Follow up with urology team and contrast pyelogram was done revealed neither congenital urethral stricture or diverticulae nor iatrogenic post procedural complications. Conclusion: Non operative distal anterior urethral stone extraction under local anaesthesia is a fast and safe option worth trying if performed by an expert clinician.
Hazem Amer has completed his Egyptian Fellowship in emergency medicine at 2008,and in 2016 he achieved membership by examination in Royal College of emergency medicine, worked as emergency medicine registrar in armed forces in KSA, where he was a member of morbidity and mortality committee, and the medical education director in emergency department in Prince Mansour Military Hospital. Joining Hamad Medical Corporation in 2013, where he became a faculty member and a mentor in residency program. He participated in educational activities, audits, headed a quality improvement project in Hamad General Hospital.
Email: doctor_hazem77@yahoo.com
