Urethral valve presenting with impacted prostatic urethral c
The present case has been published in BMJ. A 5-year-old boy presented with complaints of difficulty in micturition for the last 3 days and acute urinary retention for 1 day. History revealed symptom of occasionally crying during voiding since birth for which no medical advice was taken in the past. There was no history of any lithuria, haematuria or recurrent episodes of fever. The general physical examination was unremarkable.

The routine blood investigations and urine culture were also normal. Urine routine microscopy showed 4–5 pus cells/HPF. Ultrasonography of the abdomen revealed thickening of the bladder wall with normal upper tracts. Further evaluation with X-ray pelvis and voiding cystourethrogram (VCUG) showed a radiopaque shadow in the prostatic urethra along with dilated posterior urethra.

The patient was subsequently taken for cystopanendoscopy which revealed posterior urethral valve type one along with a dilated posterior urethra as shown in figure 2. An impacted calculus measuring approximately 10 mm was noted just proximal to PUV and it was pushed back into the bladder.

Intraoperatively, the patient’s relative was informed for presence of associated PUV and consent was taken for fulguration. The intracorporeal lithotripsy for calculus with fulguration of the PUV was performed using holmium:YAG laser. The complete stone clearance was achieved.

The postoperative period was uneventful and the patient was discharged after Foley catheter removal on postoperative day 5. On 3-month follow-up, he was voiding well with insignificant postvoid residual urine and normal upper tracts.

Learning points
• The urethral calculus and the PUV may rarely present together and usually have similar clinical presentations, especially in cases of PUV that present later in life.

• The posterior urethral valve may be rarely a predisposing factor for calculus impaction.

• It is axiomatic to keep these two conflicting conditions in mind when evaluating a child with lower urinary tract symptoms.

• Radiological imaging may not be conclusive for diagnosing the PUV in the presence of urethral calculus and cystopanendoscopy is required for definitive diagnosis and treatment.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-227317.full