Urethral calculi usually originate from the bladder and rarely from the upper tracts. Most ureteral stones that pass spontaneously into the bladder can pass through the urethra unimpeded. Urethral stones may develop secondary to urinary stasis, secondary to a urethral diverticulum, near urethral strictures, or at sites of previous surgery. Most urethral stones in men present in the prostatic or bulbar regions and are solitary. Patients with recurrent pendulous urethral calculi without evidence of other pathologic conditions should be suspected of self-introduction of such stones in an attempt to obtain pain medications or for attention, as seen in Munchausen syndrome.
Females rarely develop urethral calculi owing to their short urethra and a lower incidence of bladder calculi.
Most urethral stones found in women are associated with urethral diverticula.
Symptoms are similar to bladder calculi: intermittent urinary stream, terminal hematuria, and infection. The stones may present with dribbling or during acute urinary retention. Pain may be severe and, in men, may radiate to the tip of the penis. The diagnosis may be confirmed by palpation, endoscopic visualization, or radiographic study.
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Treatment should be directed by the underlying cause.
Stones associated with a dense urethral stricture or complex diverticula can be removed during definitive open surgical repair. Small stones may be grasped successfully and removed intact. More frequently they need to be fragmented and removed. Long-standing, large impacted stones are best removed through a urethrotomy.
Tramadol Indications and Dosage
For the treatment of moderate pain or moderately severe pain including arthralgia, headache, myalgia, dental pain following oral surgery such as extraction of impacted molars or chronic conditions such as low-back pain, bone pain and cancer-related pain.
Tramadol Maximum Dosage Limits:
- Adults: 100 mg/dose PO or 400 mg/day PO.
- Elderly >= 75 years: 100 mg/dose PO or 300 mg/day PO.
- Elderly 65 – 74 years: 100 mg/dose PO or 400 mg/day PO.
- Adolescents >= 16 years: 100 mg/dose PO or 400 mg/day PO.
- Adolescents 13 – 15 years: Maximum dosage has not been determined.
- Children: Maximum dosage has not been determined.
They may occur secondary to poor hygiene with inspissated smegma. Diagnosis is confirmed by palpation. Treating the underlying cause with a dorsal preputial slit or a formal circumcision prevents recurrent calculi.
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Marshall L. Stoller, MD
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REFERENCES
- Ackermann D et al: Influence of calcium content in mineral water on chemistry and crystallization conditions in urine of calcium stone formers. Eur Urol 1988;14:305.
- Allie-Hamdulay S et al: Prophylactic and therapeutic properties of a sodium citrate preparation in the management of calcium oxalate urolithiasis: Randomized, placebo-controlled trial. Urol Res 2005;33:116.
- Bilezikian JP et al: Primary hyperparathyroidism: New concepts in clinical, densitometric and biochemical features. J Intern Med 2005;257:6.
- Fellstrom B et al: Dietary habits in renal stone patients compared with healthy subjects. Br J Urol 1989;63:575.
- Gentle DL et al: Geriatric nephrolithiasis. J Urol 1997;158:2221.
- Heller HJ et al: Effect of dietary calcium on stone forming propensity. J Urol 2003;169:470.
- Langley SE, Fry CH: The influence of pH on urinary ionized [Ca2+]:
