Where do stones in the urethra come from?
In the vast majority of cases, the stone does not form in the urethra, but enters it from the bladder or kidney. The male urethra is long and has physiological narrowings, so a calculus often gets stuck along the way.
Stones rarely form primarily in the urethra itself - usually in a urethral diverticulum, behind a stricture or around a foreign body where urine stagnates.
- Urolithiasis and bladder stones
- Urethral stricture - the stone stops before narrowing
- Urethral diverticulum
- Foreign body around which salts build up
- Prostate adenoma with urinary stagnation
- Long-term catheterization
Symptoms of urethral stone
- Sudden interruption of the urine stream during urination
- Sharp pain in the penis, perineum, radiating to the head
- Inability to urinate when there is a strong urge
- Blood in the urine and discharge from the urethra
- Palpable dense area along the urethra
- Urine dripping
- Burning and stinging
- Sometimes the stone is visible or palpable at the external opening
Foreign bodies of the urinary tract
Foreign bodies in the bladder, urethra and ureter are more common than is commonly thought, and do not always get there from the outside.
- Medical: fragments of catheters and stents, remaining suture material, parts of endoscopic instruments
- Synthetic meshes and slings migrated into the lumen after urogynecological operations
- Forgotten or expired ureteral stents, completely covered with salts
- Objects introduced independently are a fairly common reason for referral, which patients are embarrassed to talk about
- Migrated intrauterine devices
- Shards and fragments after injuries
Why are they dangerous?
- Acute urinary retention
- Damage and rupture of the urethral wall
- Bleeding
- Urinary tract infection, ascending pyelonephritis
- Formation of cicatricial stricture of the urethra at the site of injury or prolonged stone placement
- Bedsore of the wall with the formation of a fistula
- Accumulation of salts on a foreign body with the formation of large stones
- Chronic inflammation of the bladder mucosa
Diagnostics
- Inspection and palpation of the urethra
- Ultrasound of the bladder and kidneys, determination of residual urine
- Plain radiography - X-ray positive stones and many foreign bodies are visible
- CT scan - for unclear picture and to assess the position of the object
- Urethroscopy and cystoscopy - direct examination and at the same time the possibility of removal
- Retrograde urethrography for suspected stricture or rupture
- General analysis and urine culture
Treatment
- Endoscopic removal of a stone or foreign body through the urethra is the method of choice
- Contact lithotripsy for a large or wedged stone: the stone is crushed and then the fragments are removed
- Displacement of the stone back into the bladder followed by cystolithotripsy
- Removal of ureteral foreign bodies endoscopically
- Optical urethrotomy for concomitant stricture
- Trocar cystostomy for temporary urine diversion during retention
- Open surgery - rarely, for large objects, impossibility of endoscopic access or damage to the wall
- Antibacterial therapy
- Treatment of the underlying cause: prostate adenoma, bladder stones, stricture
After removal
- Urinary control and uroflowmetry - a scar stricture may take weeks to form
- Analysis of stone composition and metabolic examination for urolithiasis
- Elimination of the cause: treatment of prostate adenoma, removal of bladder stones
- Timely replacement or removal of stents and catheters - an expired stent becomes overgrown with salts and becomes a problem itself
- Drink plenty of fluids
- Follow-up examination by a urologist
Where to contact in Tashkent
Requires 24-hour urological assistance, a cystoscopic stand, and the ability to perform contact lithotripsy.
In Tashkent, the removal of urethral stones and foreign bodies of the urinary tract is performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
The main practical advice: do not try to solve the problem yourself. One attempt at home extraction often turns a simple endoscopic intervention into the need for reconstructive surgery on the urethra. Clinic contacts are below.
