Giant Anterior Urethral Stone Complicated by Acute Urinary Retention and Bilateral Hydronephrosis: A Rare Case Report and Management Approach

Introduction: Urethral lithiasis is a less common urological pathology and accounts for about 0.3-2% of the urinary stones; this always occurs in conditions of anatomical or functional alterations of the urethra and might cause severe lower urinary tract symptoms, acute retention of urine, and serious complications. Case Presentation: We report the case of a 59-year-old hypertensive male presenting with an 8-year history of progressive LUTS complicated by bilateral lumbar pain, intermittent hematuria, and acute urinary retention. In this case, physical examination and imaging showed a large (24 x 16-mm) urethral stone obstructing the penile urethra, severe hydronephrosis on both sides, a number of diverticula involving the bladder wall, and two small stones within the bladder. The acute urinary retention was relieved by emergency cystostomy, and definitive surgery consisted of urethrolithotomy via the perineal approach and endoscopic removal of the bladder stones. Bilateral double-J stents were placed to relieve the hydronephrosis. The postoperative recovery was uneventful, with complete normalization of renal function. Spectrophotometric analysis revealed the stone to be predominantly composed of calcium oxalate monohydrate, which helped in the institution of preventive measures such as dietary modifications, increased hydration, and alkalinization of urine. Conclusion: This case highlights the difficulties of diagnosing and managing anterior urethral lithiasis, most especially large-size calculi complications. Early management, together with individual prophylaxis, ensures the avoidance of recurrences while preserving renal function.