Challenges in treating Urethral Diverticulum Giant Calculus Post-Hypospadias repair: A Case-Based Approach

Abstract

Background Urethral diverticula are a rare but recognized complication following hypospadias repair, often predisposing patients to calculi formation due to urinary stasis. Giant urethral calculi are uncommon, particularly within the anterior urethra, and present unique diagnostic and therapeutic challenges. Case Presentation We report a case of a 30-year-old male with a history of hypospadias repair, who presented with a two-year history of lower urinary tract symptoms, including dysuria, weak urinary stream, and increased frequency. Physical examination identified a hard mass in the penile urethra, and imaging confirmed a large, 6 x 2 cm urethral calculus within an anterior urethral diverticulum. After initial treatment for urinary tract infection, the patient was counseled for surgical intervention. He underwent Stage I Johansson’s Urethroplasty, which involved longitudinal urethral incision, calculus removal and urethral diverticulectomy. Postoperative recovery was smooth, with planned Stage II urethroplasty to follow. Conclusion This case highlights the importance of surgical management in cases of giant urethral calculi within diverticula, particularly in patients with prior hypospadias repair. Such cases require a tailored surgical approach to address both stone burden and anatomical complications, ensuring effective long-term outcomes and symptom relief.