Dorsal urethro-cutaneous fistula caused by an impacted stone at the bulbar urethra: Case report

BACKGROUND: Penile urethral stones are very and constitutes less than 1% of the urinary tract stones and commoner in males. They are either primary or secondary. The clinical diagnosis require high index of suspicion. CASE PRESENTATION: A 30-year-old male was complaining of penile pain, weak urinary stream and dribbling at the end of micturition for 2 months, later on he developed severe dysuria and a tender nodule over the dorsal penile surface. An attempted urethral catheterization was failed. There was no history of urethral trauma or instrumentation. Examination of genitalia revealed a normal meatus with a fistula at dorsal mid penile shaft and the urine were coming out from that opening with surrounding redness and edema with palpable firm nodule in the penile shaft. A pelvic x-ray revealed a mid-urethral radiopaque shadow, cystoscopy revealed an impacted stone in mid-bulbar urethra, attempts of stone extraction was failed. An open ventral urethral incision was made and the stone was removed, dorsal fistulectomy and repair was performed. Foley's catheter was placed and removed later after 21 days. The patient had uneventful postoperative period and the follow up was done up to 6 months with no postoperative complications. CONCLUSION: The clinical diagnosis of penile urethral stones require high index of suspicion. Management options are variable depending on impaction site, the size, and associated urethral pathologies. The fistula tract require excised and repair.