Stone in urethra causing chronic pelvic pain: LANCET case re
A 50-year-old man presented with perineal pain that had been troubling him for 5 years. He described it as a mild, dull ache that was aggravated by riding his motorcycle.

In 2014, he had mild left loin pain caused by a 1·5 cm left renal calculus; this was treated with extracorporeal shock wave lithotripsy. However, after the operation he still had the pain, and repeated ultrasound scans of his abdomen and cultures of his urine since that time showed nothing abnormal. He had sought help from many private practitioners and had been treated for chronic pelvic pain syndrome.

The patient came for a consultation in 2017 because he was still troubled by the pain. A hard swelling was felt during clinical examination of his perineum; it was palpable 4 cm above the anal verge in the midline. During urethral calibration, resistance was felt 15 cm from the urethral meatus—admitting only an infant's feeding tube of French gauge 6.

A plain x-ray of the pelvis revealed a radio-opaque shadow inferior to the pubic symphysis, and a retrograde urethrogram showed the obstruction in the bulbar urethra, suggestive of a calculus about 2 cm in diameter.

The stone was retrieved by ventral urethrotomy with a perineal approach, and at subsequent follow-up appointments the patient reported that he was doing well with complete relief from his perineal pain.

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