urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum .
urethral diverticula can present in many ways , including recurrent urinary tract infections ( utis ) , dysuria , increased urinary frequency , urgency , and hematuria .
in addition to causing the symptoms above , diverticula also can be complicated with stones or malignancy , both of which can lead to bladder outlet or urethral obstruction . stone formation has been reported to occur in 1% to 10% of patients with urethral diverticula .
urinary stasis and chronic infection have been identified as the causes of calculi formation within urethral diverticula .
the case of a woman with a giant calculus in a urethral diverticulum is reported .
a 62-year - old woman was first seen in the urology clinic complaining of a 1-year history of constant lower abdominal pain , dysuria , and dyspareunia .
she also noted an increase in the volume of the vaginal wall that coincided with an increase of pain in this area .
written informed consent was obtained from the patient for the publication of this case report and any accompanying images .
the general patient examination was normal , but a focused genital examination revealed a large mass of approximately 4  cm near the urethra .
when compressing the urethra , leakage of purulent discharge from the meatal orifice was noted . a kidney , ureter , bladder x - ray showed a giant calculi ( figure 1 ) , and cystoscopy revealed an extrusion of the posterolateral distal urethra . on admission , vital signs were all normal and laboratory tests demonstrated microscopic pyuria ( 2030/high power field ) .
the diverticulum was punctured by electrocautery and dissected with periurethral tissue , which allowed total removal of the calculi ( figure 2 ) . a tagged 3 - 0 with silk suture
the foley catheter was kept in place for 7 days . oral antibiotic therapy with ciprofloxacin
the estimated prevalence of urethral diverticula in adult women is between 0.6% and 6% , and associated stone formation is reported in 1.5% to 10% of cases .
the cause of diverticula remains largely unknown and ranges from congenital to traumatic ( instrumentation , childbirth ) to infectious causes .
the formation of abscesses and these may rupture into the urethral lumen , forming the diverticula . the quality of life of patients who have a diverticulum ( especially with calculi ) may be significantly disturbed because of complications such as dysuria , dyspareunia , uti , and postvoid dribbling .
any patient with lower urinary tract symptoms that have proved to be unresponsive to traditional treatment should be suspected of having a urethral diverticulum . in patients with urethral diverticula
other ways to confirm a diagnosis of urethral diverticula are voiding cystourethrogram , intravenous pyelography , and ultrasonography .
presumably , a stone should also be visualized within the diverticula by one of these diagnostic modalities .
the issues that remain focus on determining symptomatic relief by conservative therapy , assessing satisfactory long - term treatment of diverticulum , and determining the possible benefit from surgical excision . however , the confirmation of number , site , and size of the diverticulum is important before operation to prevent complications such as urethral stricture , urethro - vaginal fistula and incontinence due to injury of sphincter .
diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical suspicion .
thus , this diagnosis should be considered in the case of recurrent utis , hematuria , and dysuria , as well as in patients with masses felt on pelvic examination . surgical approach with litholapaxy followed by diverticulectomy
 abstracturethral diverticula with calculi have a low incidence as reported in the literature . 
 diverticulum of female urethra is rare , often discovered due to associated complications . 
 we report a case of diverticulum of the female urethra containing giant calculi in a 62-year - old multiparous woman . 
 she consulted with our office due to dysuria and a hard , painful periurethral mass in the anterior vagina wall . 
 the diverticulum was approached surgically by a vaginal route , and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms . 
INTRODUCTION
CASE REPORT
DISCUSSION