Bladder Outlet Obstruction Secondary to a Posterior Urethral Stone in a 9-Month-Old Infant

Abstract

Introduction: Bladder Outlet Obstruction (BOO) due to urethral stone in an infant is rare, and may be misdiagnosed for other common causes such as posterior urethral valves (PUV), hence it requires a higher index of suspicion. However, the lack of facilities for endoscopic surgery and stone analysis in low-resource-settings, with associated financial constraint, hinders proper evaluation and management of this condition.

This report discusses the rare presentation and management of a 9-month-old infant with BOO secondary to an obstructing posterior urethral stone, while highlighting the challenges of management of this condition in a resource limited setting. 

Patient's concerns and clinical findings

He presented on account of difficulty in passing urine of 3 weeks duration, culminating into an episode of acute urinary retention, with associated suprapubic swelling. Abdominal USS done was suggestive of PUV, however VCUG was essentially normal.

Primary diagnosis, intervention and outcome

An initial assessment of acute urinary retention secondary to BOO from suspected PUV was made, which was relieved with urethral catheterization.

He subsequently had a cystoscopy which excluded PUV, with findings of multiple bladder- trabeculations, a moderately dilated posterior- urethra and a non-impacted smooth greyish-colored stone measuring about 4mm by 5mm in the posterior urethra, for which he had an open cystolithotomy. Post operative period was uneventful, and he was discharged to be followed up in clinic for further evaluation.

He is currently voiding satisfactorily per urethra at 6 months follow-up with no recurrence of symptoms. Analysis of the stone could not be done also, due to unavailable facilities for stone analysis, and parents are unavailable to do other requested investigations due to financial constraint.

Conclusion: BOO from a urethral stone is a rare diagnosis in an infant, hence it requires a high index of suspicion. In resource limited settings, appropriate evaluation and management may be hindered, due to limitations in facilities and financial resources.