Male Urethral Diverticulum with Stones Presenting as Acute Urinary Retention

The urethral diverticulum is an outpouching of the urethral wall communicating with its lumen. Acquired male urethral diverticulum is a rare entity and arises secondary to intervention or distal urethral obstruction. Most patients present with lower urinary tract symptoms (LUTS). Development of calculi is seen in 4-10% of cases. We describe a case of a 63-year gentleman who presented with urinary tract infection (UTI) and acute urinary retention (AUR). He denied history of urolithiasis. Per-urethral catheterization failed, so a supra-pubic catheter was placed and UTI was managed with broad-spectrum parenteral antibiotics. On workup, he was found to have a large tubular urethral diverticulum in the anterior urethra with multiple stones and urethral strictures. The case was managed endoscopically with optical urethrotomy and fragmentation and retrieval of stones using a semi-rigid ureteroscope and pneumatic lithoclast.