An adult ureterocele complicated by a large stone: A case report.

INTRODUCTION: Ureterocele is a cystic dilatation of the lower part of the ureter. It is a congenital anomaly that is associated with other anomalies such as a duplicated system, and other diseases. It poses a great challenge owing to its numerous types and clinical presentations. Its incidence is 1 in every 4000 individuals. One of its presentations in the adult population is the presence of a stone, usually a solitary stone, inside the ureterocele. CASE PRESENTATION: We are reporting a case of an adult ureterocele complicated by a large calculus; managed endoscopically with transurethral deroofing of the ureterocele followed by cystolitholapaxy. A literature review was also conducted. DISCUSSION: The pathogenesis of ureteroceles is not well understood, however many proposed mechanisms exist with the incomplete dissolution of chwalla membrane being the most accepted one. The type of ureterocele and age at presentation will help guide the appropriate investigation and management, nevertheless certain goals of treatment should apply to all cases. Adult ureterocele is usually clinically silent but it may co-exist with other conditions such as a ureteral calculus and in these conditions it can be managed endoscopically. CONCLUSION: Ureteroceles complicated by stones can be effectively managed with endoscopic resection or incision of the ureterocele coupled with stone removal, however long term follow up is required to monitor for hydronephrosis and iatrogenic vesicoureteric reflux.

A rare presentation of alkaptonuria: Extensive prostatic calculi with highlight of stones found in a unique paraprostatic urethral diverticulum.

INTRODUCTION: We present a case of Alkaptonuria (AKU) presented with severe lower urinary tract symptoms (LUTS) secondary to extensive prostatic calculi deposited in the para prostatic diverticulum. Prostatic calculi are seen in chronic prostatitis, chronic pelvic pain syndrome and benign prostate hyperplasia; however, in patients with AKU, prostatic calculi and/or calcifications are more extensive. A para prostatic diverticulum is a rare entity in males; however, it should be considered in patients with AKU based on this case report. DIAGNOSIS, THERAPEUTIC INTERVENTIONS, AND OUTCOMES: A patient with AKU presented with extensive prostatic calculi that were deposited in para prostatic diverticulum, urethra and urinary bladder. The stones were successfully managed endoscopically. DISCUSSION: Paraprostatic diverticula or urethral diverticula are rare entities. They may be congenital or acquired due to recurrent Urinary Tract Infections (UTIs) or distal urethral obstruction. The distal obstruction of the urethra secondary to stones was the most likely etiology of the paraprostatic diverticulum in our case. The possible mechanisms behind stone formation in our case were chronic stasis and urinary infection within a urethral diverticulum proximal to the urethral obstruction. CONCLUSION: This case sums a rare case of AKU and paraprostatic diverticular stones; in addition, it highlights the role endoscopic management of prostatolithiasis in AKU patient.