Antegrade in situ Lasering of Distal Urethral Stone: A Novel Technique

Abstract

Different techniques are available to manage patients with urethral stones; varying from a conservative approach with spontaneous passage to open procedures. Alternative techniques include milking of stone, instilling local anesthetic jelly, pushing bang approach coupled with extracorporeal shock wave lithotripsy, lasertripsy and electrohydraulic lithotripsy. We describe a 55-year-old male patient who presented with fournier gangrene of perineum, penis and scrotum. Extensive debridement of superficial layers of perineum, scrotum and penis was performed. We put a suprapubic catheter, as per standard protocol. Thereafter, this patient had plastic surgery operations for graft placement. However, in the follow-up patient could not pass urine through urethra. Cystoscopic examination under general anesthesia revealed a stone in the distal urethra. We used a novel technique to remove this stone via an antegrade approach through the suprapubic tract and lasering the stone with holmium laser; thus avoiding open procedure and its associated complication (s). Exceptional circumstances demand thinking out of the box and in suchcases before considering open surgery one should consider this technique for the safe removal of stone.