Case Report
Volume 1 Issue 1 - 2015
Primary Giant Calculus in Female Urethral Diverticulum: Report of a Rare Case
Ahmet Tevfik Yoldemir*
Department of Obstetrics and Gynecology, Marmara University, Turkey
*Corresponding Author: Ahmet Tevfik Yoldemir, Associate Professor, Department of Obstetrics and Gynecology, Marmara University, School of Medicine, Istanbul, Turkey.
Received: January 3, 2015; Published: January 8, 2015
Citation: Ahmet Tevfik Yoldemir. “Primary Giant Calculus in Female Urethral Diverticulum: Report of a Rare Case”. EC Gynaecology 1.1 (2015): 14-18.
Urethral diverticulum occurs in approximately 0.5-6% of women. Stone formation occurs in 1.5-10% of women with urethral diverticulum. Primary (native) urethral calculi occur rarely. In this case, 47 year-old woman suffering from recurrent urinary infections for the last 2 years referred to our clinic. Physical examination was normal except for a solid mass, measuring 3x3 cm in size, under the anterior vaginal wall mucosa, located at 3cm to the external urethral orifice. Local excision of the mass was performed. Urethral calculus was removed after the incision was continued to the lumen of the diverticulum. After removing the calculi, the communication between the diverticulum and the urethral lumen was detected as the Foley catheter was seen through the vaginal incision.
Keywords: Uretral Diverticulum; Urethral calculus; Recurrent urinary infections
In women, urethral diverticulum occurs in approximately 0.5-6% of the general population. Stone formation occurs in 1.5-10% of urethral Diverticulum [1] showing us that urethral calculi in women are extremely rare. Urethral calculi originating from the kidneys or the bladder may settle in the urethra because of a diverticulum or a stricture along the flow of the urine. Primary (native) urethral calculi (composed of magnesium ammonium phosphate) occur rarely and are frequently associated with a congenital urethral diverticulum [2].
The most common symptoms of urethral diverticulum are post-micturition dribbling, dysuria and dyspareunia. Marsupialization, endoscopic transurethral diverticulectomy and excision of urethral diverticula with/without bladder neck suspension are surgical interventions available for the patients with significant symptoms. We present a case of a 47-years old woman who had a primary giant calculus in her urethral diverticulum.
Case Report
A 47-year-old woman was seen in our outpatient clinic, suffering from recurrent urinary infections for the last 2 years. In her past medical history she had no history of abdominal or flank pain, sexual or urogynecological symptoms. Physical examination was normal except for a solid mass, measuring 3x3 cm in size, under the anterior vaginal wall mucosa, located at 3 cm to the external urethral orifice. She had no stress incontinence on straining. A foley catheter was passed easily, revealing that there was no obstruction within the urethral lumen.
Plain x-ray of the lower abdomen demonstrated no calcification in the kidneys or the bladder. A renal ultrasound was performed and no significant evidence of hydronephrosis or renal calculi was detected. Translabial ultrasound revealed normal findings. The urinary sediment was within normal limits and urine culture was negative for bacteria. Pelvic Magnetic Resonance Imaging (MRI) demonstrated a vaginal cystic mass. We planned to perform a local excision of the mass.
The patient was operated under general anesthesia and a 18 Fr Foley catheter was applied. A 3-cm long, longitudinal incision was made through the anterior vaginal wall over the bulge of the stone (Figure 1). Urethral calculus was removed after the incision was continued to the lumen of the diverticulum. After removing the calculi, the communication between the diverticulum and the urethral lumen was detected as the Foley catheter was seen through the vaginal incision (Figure 2). The diverticulum was dissected with the periurethral tissue. Diverticulectomy was performed. The defect in the urethral lumen was closed with 4-0 vicryl sutures. Cystoscopy was performed and the urethral lumen was intact. The vaginal mucosa was closed in two layers with 2-0 vicryl sutures. A 18 Fr Foley catheter drainage was obtained for 7 days.
Figure 1: Longitudinal incision through the anterior vaginal wall over the bulge of the stone.

Figure 2: The communication between the diverticulum and the urethral lumen.
The stone was solid, dirty yellow, with a flat surface, 34 x 31 x 29 mm in size, and 29 grams in weight (Figure 3). Stone analysis revealed that the calculus was composed of magnesium ammonium phosphate. Her postoperative course was normal during the 3 months of follow-up. A postoperative uroflowmetry demonstrated no incontinence or voiding disorder (peak flow rate: 27 mL/sec, residual urine volume: 15 mL).
Figure 3: The stone, 29 grams in weight.

Urethral calculi are % 90 native (those formed de novo in the urethra) or migratory (those formed in the bladder or kidney with secondary descent) [3]. Most native calculi form in association with chronic stasis and urinary infection, either within a urethral diverticulum or proximal to a urethral obstruction [4]. Recurrent infections of the paraurethral glands, obstetric trauma, vaginal surgery and iatrogenic collagen injection are responsible for the ethiology [5].
Urethral calculi are rare and usually seen in men with an urethral stricture or Diverticulum [6]. Urethral calculi oftenly originate from the kidneys or the bladder and during the flow of the urine, calculi (composed of calcuim oxalate and phosphate) may settle in the urethra due to a diverticulum or a stricture. Primary urethral calculi (composed of magnesium amonium phosphate) occur rarely and are frequently associated with a congenital urethral diverticulum. In women, urethral diverticulum occur in approximately 0.6-6% of the general population [5]. Stone formation occurs in 1.5-10% of urethral diverticulum [1] showing us that urethral calculi in women are extremely rare.
Post-micturition dribbling (25% of general population ), dysuria, dyspareunia (10% of general population), chronic pelvic pain and reccurent urinary infections are the most common symptoms of urethral diverticulum; but calculi located in a diveticulum may show no urine outflow disorders. In our case the woman had no urinary symptoms. Because the clinical presentation of urethral calculi is variable and nonspesific, it frequently makes correct diagnosis more challenging to identify in women. General awareness of this condition, detailed history, physical examination and appropriately selected radiologic imaging are essential for the diagnosis. None of the diagnostic tools we used for the differential diagnosis of our case confirmed the diagnosis. Diverticulum with calculus may also be presented asymptomatically (20% of genereal population ), which was the situaiton in our case. In any case of persistent urinary symptoms unresponsive to therapy, urethral diverticulum should be examined [7].
Urinary incontinence (60% of UD), urinary recurrent infection (30% of UD) [7], urinary obstruction, calculus formation, nephrogenic adenoma and malign degeneration are the main complications of urethral diverticulum [2]. The woman in our case had no urinary flow obstruction but a painless vaginal mass. Malignity occurs due to inflammation and chronic irritation, resulting in repeated hematuria and non-calcified filling defect (adenocarcinomas are the most common histologic type) [2,8].
The most important diagnostic finding of an urethral calculus is the palpable hard mass on the anterior vaginall wall lining the urethra [5], which apparent during the vaginal examination of the woman in our case . Structures which should be differentiated from urethral diverticula are ureteroceles, inclusion cysts, malign neoplasms of urethra or vagina, ectopic ureter, Bartholin's gland cysts and Gartner’s duct cysts. Cystourethrography may be necessary to confirm the calculus in the urethral diverticulum; unless the calculus doesn't obliterate the opening of the diverticulum [3]. We did not perform this because there was no obvious obstruction in our case. Positive-Pressure Urethrography, Voiding Cystourethrography, Ultrasonography and MRI are currently used to confirm the diagnosis of the urethral diverticulum. MRI suggested the diagnosis of Bartholin’s gland cyst in our case.
Patients having urethral diverticulum with non-significant symptoms may be followed and offered conservative treatments such as antibiotics, anticholinergics, aspiration and manual postvoid decompression. Marsipualization, endoscopic transurethral diverticulectomy and excision of urethral diverticula with/without bladder neck suspension are surgical interventions available. Excision of urethral diverticula with attention to the uretral patency can be achieved easily with relief of symptoms after the operation.
  1. Skyggebjerg KD. “Female urethral diverticulum with calculus”. Acta Obstetricia et Gynecologica Scandinavica 65.7 (1986): 797-798.
  2. Aragona F., et al. “Stone formation in a female urethral diverticulum: review of the literature”. International Urology and Nephrology 21.6 (1989): 621-625.
  3. Larkin GL and JE Weber. “Giant urethral calculus: a rare cause of acute urinary retention”. The Journal of Emergency Medicine 14.6 (1996): 707-709.
  4. Ginsberg P and LH Finkelstein. “Urethral diverticulum with calculi: report of a case”. The Journal of the American Osteopathic Association 82.8 (1983): 588-590.
  5. Lee JW and MM Fynes. “Female urethral diverticula”. Best Practice & Research: Clinical Obstetrics & Gynaecology 19.6 (2005): 875-893.
  6. Suzuki Y., et al. “A case of primary giant calculus in female urethra”. International Urology and Nephrology 29.2 (1997): 237-239.
  7. Ganabathi K., et al. “Experience with the management of urethral diverticulum in 63 women”. Journal of Urology 152.5 Pt 1 (1994): 1445-1452.
  8. Seballos RM and RR Rich. “Clear cell adenocarcinoma arising from a urethral diverticulum”. Journal of Urology 153.6 (1995): 1914-191.
Copyright: © 2015 Ahmet Tevfik Yoldemir. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for August Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the August issue of respective journals. Submissions are accepted on/before July 18, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to