title: Management of impacted urethral stones in children.
abstract: OBJECTIVE
  To find out the clinical presentation, site of impaction, management and outcome of children presenting with urinary retention due to urethral stone.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Surgical Unit B of National Institute of Child Health (NICH), Karachi, from April 2009 to January 2010.
  
  
  METHODS
  All the patients under the age of 12 years, who presented with urinary retention due to impacted urethral stones were included. Urinary retention due to other causes like trauma, stricture, pelvic masses etc. were excluded. Diagnosis was made on clinical examination (palpable stone in penile urethra) and with the help of radiology. Surgical procedure was tailored according to the site of impaction in urethra. All stones were sent for chemical analysis and patients were followed in Nephrology OPD (stone clinic) for further work-up.
  
  
  RESULTS
  There were a total of 19 patients with mean age of 3.94 ± 2.27 years. All were males. Twelve patients (63.1%) had stones impacted in anterior urethra while 7 (36.9%) were found in posterior urethra. Stones in penile urethra were removed in emergency either by meatotomy (when impacted at urethral meatus, n = 3) or following initial supra-pubic decompression of urinary bladder (using wide bore cannula) by urethrolithotomy (n = 6). Stones in bulbous (n = 3) and posterior urethral (n = 7) locations were pushed back into bladder and later removed on elective list by supra-pubic vesicolithotomy. No patient had proximal urinary tract calculi on further work-up. All patients remained well except one who developed retention of urine after a week of discharge. He had urinary tract infection and was treated with antibiotics. All the stones were of calcium oxalate type.
  
  
  CONCLUSIONS
  Urethral stones must be kept in differential diagnosis in a child who presents with acute urinary retention. Clinical examination can identify causes in significant number of cases. Simple procedures like meatotomy, supra-pubic bladder decompression and urethrolithotomy can relieve the misery in these children.
authors.affiliation: Department of Paediatric Surgery, National Institute of Child Health, Rafiquee Shaheed Road, Karachi, Pakistan. jamjim88@yahoo.com
authors.forename: Jamshed
authors.initials: J
authors.lastname: Akhtar
authors.forename: Soofia
authors.initials: S
authors.lastname: Ahmed
authors.forename: Naima
authors.initials: N
authors.lastname: Zamir
mesh_terms: D002129:Calcium Oxalate / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014545:Urinary Calculi / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology* / Q000601:surgery; D013520:Urologic Surgical Procedures
chemical_list: D002129:Calcium Oxalate