A Rare Cause of Female Urinary Retention: Large Urethral Stone Leading to Bilateral Hydronephrosis

Urethral calculi are an uncommon clinical finding in females due to their relatively short and wide urethra, which typically facilitates the spontaneous passage of stones without impaction. We present a unique case of a 62-year-old female with no prior medical or surgical history who developed acute urinary retention lasting seven hours. She reported suprapubic discomfort but denied fever or flank pain. Examination revealed a distended bladder, and laboratory investigations, including renal function and inflammatory markers, were normal. Computed tomography kidneys, ureter, bladder (CT KUB) revealed a markedly distended bladder, bilateral moderate hydronephrosis, and a 2.5-cm longitudinal stone within the urethra. No renal or ureteric stones were identified. A Foley catheter was inserted successfully, draining urine and relieving symptoms, and the patient was discharged with the catheter in place for follow-up. She presented a few days later after accidental dislodgement of the Foley catheter at home. Examination revealed a portion of the stone protruding from the urethral meatus. Under appropriate analgesia and sterile technique, the entire stone was successfully removed in one piece using forceps. The patient remained stable and was monitored for post-obstructive diuresis. This case illustrates a rare presentation of a large female urethral stone causing acute urinary retention and bilateral hydronephrosis. It also highlights the potential for spontaneous expulsion and the importance of considering urethral stones in female patients with urinary retention. Due to the rarity of such presentations, this case adds valuable insight to the limited literature on urethral stones in women.