Overcoming Urinary Pain and Blockage: A 32-Year-Old Man's Recovery from Lower Urinary Tract Stones

Disclaimer: This article is intended solely for educational and informational purposes. To protect patient privacy, all personal details have been modified or anonymized.

Case Summary: Effective Treatment of Lower Urinary Tract Obstruction

A 32-year-old male presented with sudden-onset urinary difficulty and severe dysuria (painful urination). With a prior history of ureteral stones, clinical evaluation and imaging confirmed a diagnosis of lower urinary tract calculi—specifically, a large stone obstructing the anterior urethra, accompanied by left hydronephrosis. After undergoing minimally invasive holmium laser lithotripsy via cystoscopy, combined with short-term antibiotic therapy, the stone was successfully fragmented and expelled. Postoperative recovery was smooth, with complete resolution of symptoms. Follow-up imaging showed significant improvement in kidney swelling, highlighting the importance of timely intervention and preventive lifestyle changes.

Patient Profile at a Glance

Age & Gender: 32-year-old male
Diagnosis: Lower urinary tract stone, secondary to migrated upper tract calculus; left-sided hydronephrosis
Hospital: Zhengzhou First People's Hospital
Date of Admission: February 2021
Treatment Approach: Surgical intervention (transurethral cystoscopic holmium laser lithotripsy) + pharmacological support (levofloxacin tablets, Relin Qing granules)
Hospital Stay: 3 days
Follow-Up Schedule: Outpatient visits scheduled at 7 days, 1 month, and 3 months post-discharge
Outcome: Complete elimination of urethral stone, symptom relief, and progressive resolution of renal complications

Initial Clinical Assessment: Recognizing the Signs Early

In early February 2021, during a routine outpatient clinic session, a man in his early thirties walked into the examination room visibly distressed. He reported that over the past 24 hours, he had experienced increasing difficulty urinating, along with sharp pain during voiding. Initially, he could only pass small amounts of urine with great effort—what doctors call "dribbling." By morning, he was completely unable to urinate despite straining, a condition known as acute urinary retention.

Physical examination revealed a distended lower abdomen and a palpable hard mass near the base of the penis, approximately 1 cm in diameter, consistent with an impacted urethral stone. Upon further questioning, the patient recalled being diagnosed one month earlier with a left distal ureteral stone measuring about 1 cm. Though advised to pursue treatment, he delayed due to work commitments and because his flank pain had subsided.

Given the high diagnostic accuracy of CT scans—nearly 99% for detecting urinary stones—a non-contrast CT urogram was promptly ordered. The imaging confirmed a 1.2 x 1.0 cm stone lodged in the anterior urethra and revealed moderate left hydronephrosis with a 2 cm separation of the renal pelvis, indicating impaired drainage from the kidney.

Therapeutic Intervention: Immediate Relief and Definitive Treatment

After explaining the findings and risks of untreated obstruction, we initiated emergency management. Using a urethral sound, the stone was gently pushed back into the bladder under sterile conditions. A Foley catheter was then inserted, immediately draining around 420 ml of pale yellow urine—providing instant relief from urinary retention.

The patient was admitted for definitive surgical treatment. Within hours, he underwent transurethral cystoscopic holmium laser lithotripsy. During the procedure, a spherical, light-yellow stone was visualized inside the bladder. Utilizing the precision of the holmium laser system, the stone was fragmented into tiny particles and removed through the cystoscope sheath. Final inspection confirmed no residual fragments, and a urinary catheter was left in place temporarily.

Postoperatively, a three-day course of oral levofloxacin was prescribed to prevent infection. On the third day, the catheter was removed, and the patient reported normal, pain-free urination. He was discharged with clear instructions for follow-up care and lifestyle modifications.

Recovery and Long-Term Outcome

The treatment proved highly effective. All stone fragments were cleared, and urinary function returned to normal without complications. While mild discomfort occurred briefly after catheter removal, it resolved quickly without additional medication.

At the first follow-up visit seven days later, the patient confirmed continued improvement—no pain, strong urinary stream, and no signs of infection. One month post-surgery, a repeat renal ultrasound showed a reduction in left hydronephrosis from 2 cm to 1 cm. By the three-month mark, imaging revealed complete normalization: both kidneys appeared healthy, with no hydronephrosis or ureteral dilation.

These results confirm not only successful stone removal but also the reversal of secondary kidney damage caused by prolonged obstruction. The patient expressed full satisfaction with the outcome and committed to making lasting lifestyle adjustments to reduce recurrence risk.

Key Recommendations for Prevention and Wellness

While modern urology offers excellent solutions for treating urinary stones, prevention remains the best strategy. I strongly advise individuals—especially those with a history of kidney or ureteral stones—to adopt these daily habits:

Stay Hydrated: Aim for at least 2.5–3 liters of water per day to maintain dilute urine and discourage crystal formation.
Urinate Frequently: Don't delay urination. Holding urine increases mineral concentration and stone development risk.
Eat Water-Rich Foods: Incorporate fruits like watermelon, oranges, and tomatoes, which are naturally hydrating and rich in citrate—a natural inhibitor of stone formation.
Exercise Regularly: Physical activity supports metabolic health and may help prevent stone recurrence.
Seek Prompt Medical Attention: If you experience sudden urinary hesitation, burning, or inability to void, do not ignore it. Early diagnosis can prevent serious complications like kidney damage or sepsis.

Clinical Insights: Lessons Learned from This Case

This case underscores several critical points in urological practice. First, many lower urinary tract stones originate as migrating upper tract calculi—especially those larger than 1 cm. Therefore, any patient presenting with acute urinary retention should be asked about prior kidney or ureteral stone diagnoses.

Second, when managing impacted urethral stones, the priority is relieving obstruction. Pushing the stone back into the bladder using a urethral probe or catheter is often the safest first step, especially in cases of urinary retention. This avoids trauma and sets the stage for controlled surgical fragmentation.

Third, performing lithotripsy directly within the urethra carries a higher risk of urethral injury and stricture formation. It's generally safer and more effective to relocate the stone to the bladder before breaking it apart endoscopically.

Finally, this case highlights the value of patient education. Had the patient followed up on his initial ureteral stone diagnosis, this entire episode might have been prevented. Awareness, adherence to medical advice, and proactive self-care are essential components of long-term urinary health.