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Abstract: This case refers to a 54-year-old male patient who presented to the hospital with a primary cause of dyspareunia, pain, and hematuria. The patient’s previous physical examination revealed scattered fine stones in both kidneys. It was first suspected that the patient had an obstruction due to the relatively slender narrowing of the urethra when part of the stone was discharged down through the urethra. After CT examination, it was confirmed that the urinary tract stones were embedded. After hospitalization, Holmium laser lithotripsy was performed to remove the stones, and the patient was discharged successfully.
Basic information】Male, 54 years old
Disease Type】Urinary tract stones
Hospital】Associated Hospital of Fujian Medical University
Date of Consultation】June 2021
Treatment plan】Surgical treatment (Holmium laser lithotripsy for urethral stones)
Treatment Period】3 days of inpatient treatment, 1 month of outpatient follow-up
Results】Urethral stones were crushed and removed, pain was relieved, and urination was clear.
I. Initial consultation
The patient was a 54-year-old male who came to our hospital mainly because of difficulty in urination, pain and hematuria. The patient was found to have small stones scattered in both kidneys during the previous physical examination. From the patient’s description, I suspected that the onset of the disease was due to the obstruction of the urethra due to the relatively long and narrow urethra when some of the stones were discharged down through the urethra, causing difficulty in urination, severe pain and hematuria. After communication with the patient, a further CT scan was performed and the results returned: there was an obvious urinary stone impaction. The main procedure was holmium laser lithotripsy for urethral stones, and the patient agreed and cooperated actively.
II. Treatment process
Before the operation, we communicated with the patient about the intraoperative risks and informed him that intraoperative complications such as ureteral and urethral injury and bleeding might occur, but the incidence was very low and he should not worry about them.
During the operation, we confirmed that the stone was embedded in the urethral membrane, and there was local mucosal injury and bleeding, so we inserted the ureteroscope and Holmium laser to focus on the stone, and broke up most of the stone to restore the patency of the urethra. The patient was successfully transferred to the ward.
III. Treatment effect
With surgical treatment, the stones were broken and removed with as little damage as possible to the mucosa of the urethra, restoring the patency of the urethra and relieving the obstruction and pain. After surgery, the patient’s pain symptoms were significantly improved within a short period of time, and urethral patency was restored on the second day after surgery. At the time of discharge, the patient was instructed to follow up as an outpatient in 1 month. In conclusion, the urethral stone was broken and removed, and the pain was relieved and the urination was smooth, so the treatment effect was good.
IV. Precautions
We are sincerely happy for the patient’s recovery through surgical treatment. Before the patient was discharged from the hospital, he was advised that although the pain was relieved and the urine was passed smoothly after the surgery, he still needed to pay attention to the regular review of the urinary stones and if the stones moved down the ureter or urethra again, he needed to go to the urology clinic in time to confirm whether the stones were embedded.
In daily life, we need to pay attention to timely adjustment of living habits, good living habits will help the recovery of the disease. First of all, increase the amount of water you drink. Drinking a lot of water will increase the urine and also reduce the concentration of stone material in the urine. Diet, mainly low salt, high vitamin diet, high fiber food, more fresh fruits and vegetables, increase the intake of coarse grains, can reduce the formation of stone material in the urine, avoid eating food containing calcium oxalate.
V. Personal insight
The main reason why this patient had painful urination and hematuria symptoms is that the urinary stones were not discharged in time after falling into the bladder through the ureter, and gradually became too large to be discharged by themselves through the slender urethra, and became embedded in the physiologically narrow section of the urethra, resulting in difficulty and severe pain in urination. Therefore, it is important to prevent stone formation in daily life, strengthen physical activity and avoid being sedentary. In modern life, the pace of life is accelerating and the work pressure is high, often forgetting to drink water and being sedentary when working, such patients should pay particular attention to the prevention and treatment of urinary stones.