Presentation, management, metabolic evaluation and long-term outcomes of pediatric urethral calculi

Abstract Purpose Evidence regarding pediatric urethral calculi is limited, and important questions remain regarding their optimal management, associated metabolic abnormalities, and long-term outcomes. We aimed to comprehensively characterize the clinical presentation, management, metabolic profile, and long-term outcomes of children with urethral calculi treated at a tertiary pediatric referral center. Methods Children younger than 18 years with radiologically and/or endoscopically confirmed urethral calculi were retrospectively reviewed. Demographic characteristics, presenting symptoms, imaging findings, stone characteristics, treatment modality, operative outcomes, associated upper urinary tract stone disease, metabolic evaluation, recurrence, and long-term follow-up were analyzed. All patients underwent standardized 24-hour urine metabolic evaluation after spontaneous or surgical stone clearance using age-specific reference values. Results Fourteen children (10 boys and 4 girls) with a median age of 4.5 years were included. Acute urinary retention and gross hematuria were the most common presenting symptoms (both 57.1%). Twelve patients (85.7%) had impacted urethral calculi, and six (42.9%) had associated upper urinary tract stones requiring subsequent retrograde intrarenal surgery (n=3) or percutaneous nephrolithotomy (n=3). Endoscopic holmium laser lithotripsy was performed in nine patients, meatotomy in three, and spontaneous stone passage occurred in two. Standardized metabolic evaluation identified hypocitraturia in all patients, hypercalciuria in seven (50.0%), hyperoxaluria in two (14.3%), and cystinuria in one patient with a cystine stone. Urethral stone clearance was achieved in all children. During a median follow-up of 54 months, only one recurrence occurred, and no patient developed urethral stricture, meatal stenosis, persistent voiding dysfunction, or procedure-related complications. Conclusion Pediatric urethral calculi frequently represent the presenting manifestation of a broader urinary stone disease rather than an isolated urethral event. Location-adapted minimally invasive management, including in-situ holmium laser lithotripsy for impacted calculi, achieved excellent long-term outcomes without urethral complications. Comprehensive urinary tract imaging, standardized metabolic evaluation, and multidisciplinary follow-up should be considered integral components of the comprehensive evaluation and management of children with urethral calculi.