Pediatric Urethral Calculus Management in a Resource-Limited Setting: A Case Report and Review of the Literature

Abstract

Caleb Brown*, Jennifer Osher, Ismael Kaitama and Andrew Trecartin

Urethral calculi are an uncommon cause of acute urinary retention in children, particularly in low-resource settings where delays in presentation and limited technology complicate management. We report the case of a 5-year-old boy who presented to a rural district hospital in Chad with four days of complete urinary retention and progressive abdominal distention. Examination revealed a palpable mass at the penoscrotal junction, consistent with distal urethral obstruction. Point-of-care ultrasound demonstrated a markedly distended bladder but did not visualize a urethral stone. Initial suprapubic diversion was performed using an intravenous catheter. Under anesthesia the following day, gentle instillation of lubricating gel into the urethral meatus displaced the stone into the bladder, confirmed on repeat ultrasound. Definitive management was achieved with open suprapubic cystolithotomy, and the patient recovered uneventfully, regaining normal voiding function. He was also treated with Praziquantel for presumptive schistosomiasis, a common regional risk factor for stone formation. This case highlights the importance of adaptable, resource-appropriate strategies for pediatric urethral calculi. Simple maneuvers such as retrograde displacement with lubricating gel, combined with open cystolithotomy when minimally invasive options are unavailable, can provide safe and effective treatment. Recognition and treatment of underlying contributors remain essential to preventing recurrence.