Presentation, Management, Metabolic Evaluation and Long-Term Outcomes of Pediatric Urethral Calculi
This retrospective study of 14 children with urethral calculi demonstrates that these stones often signal broader urinary stone disease, are frequently associated with metabolic abnormalities like hypocitraturia, and can be effectively managed with location-adapted minimally invasive techniques yielding excellent long-term outcomes with minimal recurrence or complications.
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Stone disease in children is a condition that has become more common around the world over the last twenty years. While most urinary stones form in the kidneys or the tubes that carry urine down to the bladder, a rare and urgent variation occurs when a stone gets stuck in the urethra, the final tube that carries urine out of the body. This blockage can cause sudden pain, an inability to urinate, or blood in the urine. Because these events are rare, doctors have historically relied on small case reports to understand how best to treat them, often leaving big questions unanswered about why these stones form, whether they are connected to other stones higher up in the system, and what happens to the child's health years after the stone is removed.
A team of researchers at a specialized pediatric hospital in Turkey set out to answer these questions by looking closely at fourteen children who had been treated for stones stuck in their urethras. The group included ten boys and four girls, with a median age of four and a half years. The researchers reviewed the children's medical records to see how the stones presented, how they were removed, what the stones were made of, and whether any hidden metabolic problems were driving the stone formation. They also followed the children for a long time—about four and a half years on average—to see if the stones came back or if the treatment caused any lasting damage to the urethra.
The children arrived at the hospital with a mix of symptoms. While the classic sign of a blocked urethra is the sudden inability to urinate, which happened in eight of the children, an equal number arrived with visible blood in their urine. Some also had infections or noticed their urine stream dribbling. The stones themselves varied in size, with the middle-sized stone measuring about six and three-quarter millimeters across. In most cases, the stone was firmly stuck and could not pass on its own. The researchers found that the stones were located in different parts of the urethra, from the very opening to deeper sections near the bladder.
What made this study particularly revealing was the discovery that for nearly half of these children, the urethral stone was not an isolated event. Six of the fourteen children also had stones in their kidneys or upper urinary tract. This suggests that when a child presents with a stone in the urethra, it is often just the most visible part of a broader stone disease affecting the entire urinary system. Because of this, the medical team did not stop their work after clearing the urethra. They performed additional procedures on six children to remove the other stones, using either a scope passed up through the urethra or a small incision in the back to reach the kidney directly.
To understand why these stones formed, the researchers conducted a thorough chemical analysis of the urine from every child after the stones were cleared. They looked for imbalances in the substances that can turn into stones. The results showed that every single child had low levels of citrate, a natural substance in urine that normally helps prevent stones from forming. Half of the children had too much calcium in their urine, and a few had excess oxalate. One child had a specific genetic condition that caused cystine stones. These findings confirmed that metabolic issues are a universal driver in these cases, meaning that simply removing the stone is not enough; the underlying chemical imbalance must be managed to prevent recurrence.
The treatment approach used by the team was tailored to where the stone was located and how stuck it was. For stones at the very opening, a small surgical cut or waiting for them to pass naturally was sometimes enough. For the stones stuck deeper inside, the team used a specialized laser to break them apart while they were still in place, rather than trying to push them back into the bladder. This method, which uses a very fine fiber to deliver gentle pulses of energy, allowed the doctors to fragment the stones without damaging the delicate lining of the urethra. The procedure was successful in clearing the urethra for all fourteen children.
The long-term follow-up provided reassuring news about the safety of this approach. Over the course of the study, only one child experienced a new stone forming, and none of the children developed scarring, narrowing of the urethra, or problems with urination that lasted after the procedure. The researchers concluded that treating pediatric urethral stones requires a comprehensive strategy. It is not enough to just remove the blockage; doctors must also check the entire urinary system for other stones and perform a detailed metabolic evaluation to find and treat the chemical causes. By combining careful, minimally invasive surgery with a deep understanding of the child's internal chemistry, the team achieved excellent results, ensuring that these rare cases do not lead to long-term harm.
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