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